Impact of Obstetric Unit Closures on Pregnancy Outcomes

描述（由申请人提供）：鉴于每年有超过400万婴儿在医院分娩，提供产科护理是卫生保健系统的重要组成部分。虽然在一个特定的地理区域产科床位的最佳供应是未知的，产科单位关闭是一个常见的现象。加州医院以前的工作表明，当一家医院取消某些服务领域时，产科护理是最常见的被取消的服务领域。导致这些关闭的因素有很多，包括不断增加的医疗事故保费、经济损失和对诉讼的恐惧。此外，这些关闭往往不成比例地影响少数民族和低收入社区。鉴于每年有大量妇女接受产科护理，产科关闭可能对社区的健康结果产生重大影响，这似乎是合理的。然而，没有很好地描述这些关闭对周围人口健康的影响。我们的小组以前调查过费城，那里19个产科单位中有9个在1995年至2005年间关闭。这项研究表明，与1995-1996年关闭前相比，产科床位供应的减少导致新生儿和所有胎儿死亡率最初增加，通过剖宫产分娩的数量最初和后期下降。这一观察结果提出了多个问题，即即使是少数产科单位关闭对产科护理的短期和长期结果的影响。没有研究这些产科关闭对(a)居住在关闭的产科单位附近的患者和(b)较大地理区域内的患者的成本、结果和护理质量的影响，也没有研究了解卫生保健市场和关闭的医院的特征如何改变这些关联。我们在费城的研究结果和一项研究表明，在密苏里州农村地区，产科服务停止后，低出生体重婴儿的患病率增加，这突出了开展专门研究评估产科关闭后孕产妇和新生儿结局的必要性。如果产科病房的关闭实际上对直接社区和周围社区都产生不利影响，那么在准备关闭产科病房以对抗这些不利影响时，就有可能在社区中产生重大的系统变化。在向医院管理人员、产科领导和政府官员提供指导意见，建议利用大量资源来应对产科关闭的影响之前，需要进行严格的研究，研究关闭对孕产妇和新生儿结局的影响。研究关闭一项每年影响400多万妇女及其家庭的服务的影响具有重要的社会意义。

DESCRIPTION (provided by applicant): Given the fact that over 4 million infants are delivered in hospitals every year, the provision of obstetric care is a critical part of the health care system. Although the optimal supply of obstetric beds in a given geographic region is unknown, obstetric unit closures are a common occurrence. Prior work from California hospitals has shown that, when a hospital is eliminating certain service areas, obstetric care was the most common service area to be eliminated. There are many factors contributing to these closures including increasing malpractice premiums, financial losses and fear of litigation. Additionally, these closures often disproportionately affect minority and low-income communities. Given the large number of women annually that receive obstetric care, it is plausible that obstetric closures can have a significant impact on the health outcomes of communities. However, the impact of these closures on the health of the surrounding population is not well described. Our group has previously investigated Philadelphia, where 9 of 19 obstetric units closed between 1995 and 2005. This study showed that, compared to a pre-closure period of 1995-1996, this reduction in obstetric bed supply resulted in an initial increase in neonatal and all fetal mortality, an initial and late decline in the number of deliveries via Cesarean section. This observation raises multiple questions about the impact of even a small number of obstetric unit closures on short-term and long-term outcomes of obstetric care. There are no studies of the impact of these obstetric closures on the costs, outcomes, and quality of care for both (a) patients who reside close to the closed obstetric unit and (b) patients within the larger geographic area, nor are there studies to understand how characteristics of the health care market and the hospitals that close modify these associations. Our findings in Philadelphia and a study demonstrating increased prevalence in babies with low birth weight in rural Missouri after discontinuation of obstetric services, highlight the need to have specific studies dedicated to evaluating maternal and neonatal outcomes after obstetric unit closures. If in fact obstetric unit closures adversely impacts both the immediate and surrounding communities, there is the potential to create significant systems changes in communities when preparing for a closure to combat these adverse affects. Prior to providing guidance to hospital administrators, obstetrical leaders, and government officials suggesting significant resource utilization to combat obstetric unit closure affects, rigorous research is needed to study the effect of closures on maternal and neonatal outcomes. Studying the impact of closing a service that impacts over 4 million women and their families each year is of great societal importance. . PUBLIC HEALTH RELEVANCE: Although over 4 million infants delivering in the United States every year, the reduction of obstetric services through the closure of obstetric units is a common occurrence. This application will investigate the impact of obstetric unit closures on the pregnancy outcomes of both the larger community and the smaller community serviced by the closed obstetric unit. Improved understanding of the impact of such service reductions in the obstetric market will result in more efficient use of health care services and optimize the value of health care dollars spent on obstetric care.