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Regionalized Perinatal Care: An Evidence-Based Intervention in Development

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Reducing Racial/Ethnic Disparities in Reproductive and Perinatal Outcomes

Abstract

Regionalized perinatal care is an on-going effort to systematically organize and coordinate health care for expectant mothers and newborns. In the 1960s and 1970s, academic clinicians and public health experts pioneered regionalized perinatal services in response to new neonatal care technologies and expanding but still limited expertise (Committee on Perinatal Health, 1976; Graven, Howe, & Callon, 1976). By design, regionalization prioritizes the distribution of clinical care and technologies to women and infants according to risk. The spectrum of regionalized services ideally spans from preconception planning to infant health, although the concept is more commonly associated with the inpatient obstetric and neonatal services that women and infants receive in the hours and days surrounding birth. This chapter provides an evidence-based evaluation of regionalized perinatal care, its role and potential to reduce racial and ethnic disparities in perinatal outcomes, and illustrates the need for a broader implementation if its goals are to be fully realized.

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References

  • Allen, M. C., Alexander, G. R., Tompkins, M. E., & Hulsey, T. C. (2000). Racial differences in temporal changes in newborn viability and survival by gestational age. Paediatric and Perinatal Epidemiology, 14(2), 152–158.

    Article  CAS  PubMed  Google Scholar 

  • American Academy of Pediatrics. Committee on Fetus and Newborn. (1985). Manpower needs in neonatal pediatrics. Pediatrics, 76(1), 132–135.

    Google Scholar 

  • American Academy of Pediatrics. Committee on Fetus and Newborn. (2004). Levels of neonatal care. Pediatrics, 114(5), 1341–1347.

    Article  Google Scholar 

  • American Academy of Pediatrics & The American College of Obstetricians and Gynecologists. (2007). Guidelines for perinatal care (6th ed.). Washington, DC: Author.

    Google Scholar 

  • Berger, G. S., Udry, J. R., & Hendricks, C. H. (1975). Regionalized perinatal care: An estimate of potential effect on racial differences in perinatal mortality in North Carolina. North Carolina Medical Journal, 36(8), 476–479.

    CAS  PubMed  Google Scholar 

  • Bronstein, J. M., Capilouto, E., Carlo, W. A., Haywood, J. L., & Goldenberg, R. L. (1995). Access to neonatal intensive care for low-birthweight infants: The role of maternal characteristics. American Journal of Public Health, 85(3), 357–361.

    Article  CAS  PubMed  Google Scholar 

  • Carmichael, S. L., & Iyasu, S. (1998). Changes in the black-white infant mortality gap from 1983 to 1991 in the United States. American Journal of Preventive Medicine, 15(3), 220–227.

    Article  CAS  PubMed  Google Scholar 

  • Centers for Disease Control and Prevention (CDC). (2005). “Racial/ethnic disparities in infant mortality–United States, 1995–2002.” MMWR Morb Mortal Wkly Rep. 10, 54(22), 553–556.

    Google Scholar 

  • Chien, L., Whyte, R., Aziz, K., Thiessen, P., Matthew, D., & Lee, S. (2001). Improved outcome of preterm infants when delivered in tertiary care centers. Obstetrics and Gynecology, 98(2), 247–252.

    Article  CAS  PubMed  Google Scholar 

  • Cifuentes, J., Bronstein, J., Phibbs, C., Phibbs, R., Schmitt, S., & Carlo, W. (2002). Mortality in low birth weight infants according to level of neonatal care at hospital of birth. Pediatrics, 109, 745–751.

    Article  PubMed  Google Scholar 

  • Committee on Perinatal Health. (1976). Toward improving the outcomes of pregnancy: Recommendations for the regional development of maternal and perinatal health services. (TIOP I). White Plains, NY: March of Dimes.

    Google Scholar 

  • Committee on Perinatal Health. (1993). Toward improving the outcomes of pregnancy: The 90s and beyond. (TIOP II). White Plains, NY: March of Dimes.

    Google Scholar 

  • Dooley, S., Freels, S., & Turnock, B. (1997). Quality assessment of perinatal regionalization by multivariate analysis: Illinois. Obstetrics and Gynecology, 89, 193–198.

    Article  CAS  PubMed  Google Scholar 

  • Gagnon, D., Allison-Cooke, S., & Schwartz, R. (1988). Perinatal care: The threat of deregionalization. Pediatric Annals, 17, 447–452.

    CAS  PubMed  Google Scholar 

  • Goodman, D. C., Fisher, E. S., Little, G. A., Stukel, T. A., & Chang, C. H. (2001). Are neonatal intensive care resources located according to need? Regional variation in neonatologists, beds, and low birth weight newborns. Pediatrics, 108(2), 426–431.

    Article  CAS  PubMed  Google Scholar 

  • Goodman, D. C., Fisher, E., Little, G., Stukel, T., Chang, C., & Schoendorf, K. (2002). The relation between availability of neonatal intensive care and neonatal mortality. New England Journal of Medicine, 346, 1538–1544.

    Article  PubMed  Google Scholar 

  • Gortmaker, S., Sobol, A., Clark, C., Walker, D. K., & Geronimus, A. (1985). The survival of very low-birth weight infants by level of hospital of birth: A population study of perinatal systems in four states. American Journal of Obstetrics and Gynecology, 152(5), 517–524.

    CAS  PubMed  Google Scholar 

  • Gould, J. B., Sarnoff, R., Liu, H., Bell, D. R., & Chavez, G. (1999). Very low birth weight births at non-NICU hospitals: The role of sociodemographic, perinatal, and geographic factors. Journal of Perinatology, 19(3), 197–205.

    Article  CAS  PubMed  Google Scholar 

  • Graven, S. N., Howe, G., & Callon, H. (1976). Perinatal health care studies and program results in Wisconsin, 1964–1970. In P. A. Swyer & J. A. Stetson (Eds.), Neonatal intensive care. St. Louis, MO: Charles Green Publisher.

    Google Scholar 

  • Handler, A., Rosenberg, D., Driscoll, M., Cohen, M., Swift, E., Garcia, P., et al. (1991). Regional perinatal care in crisis: A case study of an urban public hospital. Journal of Public Health Policy, 12(2), 184–198.

    Article  CAS  PubMed  Google Scholar 

  • Hashimoto, L. N., Lindsell, C. J., Brewer, D. E., Eichel, M. M., & Donovan, E. F. (2004). Contributions of infertility treatment to very-low-birth-weight multiple birth infants receiving neonatal intensive care. American Journal of Obstetrics and Gynecology, 190(2), 401–406.

    Article  PubMed  Google Scholar 

  • Healthy Children 2000. (n.d.). National health promotion and disease prevention objectives. Retrieved August 22, 2007, from http://odphp.osophs.dhhs.gov/pubs/hp2000/.

  • Hein, H. A., & Lathrop, S. S. (1986). The changing pattern of neonatal mortality in a regionalized system of perinatal care. American Journal of Diseases of Children, 140(10), 989–993.

    CAS  PubMed  Google Scholar 

  • Heller, G., Richardson, D. K., & Schnell, R. (2002). Are we regionalized enough? Early neonatal death in low-risk births by the size of delivery units in Hesse, Germany. International Journal of Epidemiology, 31, 1061–1068.

    Article  PubMed  Google Scholar 

  • Horbar, J. D., Badger, G. J., Lewit, E. M., Rogowski, J., & Shiono, P. H. (1997). Hospital and patient characteristics associated with variation in 28-day mortality rates for very low birth weight infants. Vermont Oxford Network. Pediatrics, 99(2), 149–156.

    Article  CAS  PubMed  Google Scholar 

  • Howell, E., & Vert, P. (1993). Neonatal intensive care and birth weight-specific perinatal mortality in Michigan and Lorraine. Pediatrics, 91, 464–469.

    CAS  PubMed  Google Scholar 

  • Jenny, A. M., Schoendorf, K. C., & Parker, J. D. (2001). The association between community context and mortality among Mexican-American infants. Ethnicity & Disease, 11, 722–731.

    CAS  Google Scholar 

  • Johnson, K. A., & Little, G. A. (1999). State health agencies and quality improvement in perinatal care. Pediatrics, 103(1 Suppl. E), 233–247.

    CAS  PubMed  Google Scholar 

  • Johnson, K., Posner, S. F., Biermann, J., Cordero, J. F., Atrash, H. K., Parker, C. S., et al. (2006). Recommendations to improve preconception health and health care – United States. A report of the CDC/ATSDR Preconception Care Work Group and the Select Panel on Preconception Care. MMWR. Recommendations and Reports, 55(RR-6), 1–23.

    Google Scholar 

  • Kirby, R. (1996). Perinatal mortality: The role of hospital birth. Journal of Perinatology, 16, 43–49.

    CAS  PubMed  Google Scholar 

  • Koontz, A. M. (1984). Pregnancy and infant health: Progress toward the 1990 objectives. Public Health Reports, 99(2), 184–192.

    CAS  PubMed  Google Scholar 

  • Kugler, J. P., Connell, F. A., & Henley, C. E. (1990). Lack of difference in neonatal mortality between blacks and whites served by the same medical care system. Journal of Family Practice, 30(3), 281–288.

    CAS  PubMed  Google Scholar 

  • Langkamp, D., Foye, H., & Roghmann, K. (1990). Does limited access to NICU services account for higher neonatal mortality rates among blacks? American Journal of Perinatology, 7, 227–231.

    Article  CAS  PubMed  Google Scholar 

  • LeFevre, M., Sanner, L., Anderson, S., & Tsutakawa, R. (1992). The relationship between neonatal mortality and hospital level. Journal of Family Practice, 35(3), 259–264.

    CAS  PubMed  Google Scholar 

  • Lubchenco, L. O., Butterfield, L. J., Delaney-Black, V., Goldson, E., Koops, B. L., & Lazotte, D. C. (1989). Outcome of very-low-birth-weight infants: Does antepartum versus neonatal referral have a better impact on mortality, morbidity, or long-term outcome? American Journal of Obstetrics and Gynecology, 160, 539–545.

    CAS  PubMed  Google Scholar 

  • Lui, K., Abdel-Latif, M. E., Allgood, C. L., Bajuk, B., Oei, J., Berry, A., et al. (2006). Improved outcomes of extremely premature outborn infants: Effects of strategic changes in perinatal and retrieval services. Pediatrics, 118, 2076–2083.

    Article  PubMed  Google Scholar 

  • March of Dimes. (n.d.). March of Dimes Prematurity Campaign. Retrieved August 30, 2007, from http://www.marchofdimes.com/prematurity/5408_5576.asp.

  • Mathews, T. J., Menacker, F., & MacDorman, M. F. (2004). Infant mortality statistics from the 2002 period linked birth/ infant death data set. National Vital Statistics Reports (Vol. 53). Hyattsville, MD: National Center for Health Statistics.

    Google Scholar 

  • Mayfield, J., Rosenblatt, R., Baldwin, L., Chu, L., & Logerfo, J. (1990). The relation of obstetrical volume and nursery level of perinatal mortality. American Journal of Public Health, 80, 819–823.

    Article  CAS  PubMed  Google Scholar 

  • McCormick, M., Shapiro, S., & Starfield, B. (1985). The regionalization of perinatal services. Summary of the evaluation of a national demonstration program. New England Journal of Medicine, 253, 799–804.

    CAS  Google Scholar 

  • Mehta, S., Atherton, H., Schoettker, P., Hornung, R., Perlstein, P., & Kotagal, U. (2000). Differential Markers for Regionalization. Journal of Perinataology, 20(6), 366–372.

    Article  CAS  Google Scholar 

  • Menard, M., Liu, Q., Holgren, E., & Sappenfield W. (1998). Neonatal mortality for very low birth weight deliveries in South Carolina by level of hospital perinatal service. American Journal of Obstetrics and Gynecology, 179(2), 372–381.

    Article  Google Scholar 

  • Merlo, J., Gerdtham, U., Eckerlund, I., Hakansson, S., Olausson, O. P., Pakkanen, M., et al. (2005). Hospital level of care and neonatal mortality in low- and high-risk deliveries. Medical Care, 43(11), 1092–1100.

    Article  PubMed  Google Scholar 

  • Morales, L. S., Staiger, D., Horbar, J. D., Carpenter, J., Kenny, M., Geppert, J., et al. (2005). Mortality among very low-birthweight infants in hospitals serving minority populations. American Journal of Public Health, 95(12), 2206–2212.

    Article  PubMed  Google Scholar 

  • Morse, S. B., Wu, S. S., Ma, C., Ariet, M., Resnick, M., & Roth, J. (2006). Racial and gender differences in the viability of extremely low birth weight infants: A population-based study. Pediatrics, 117(1), 106–112.

    Article  Google Scholar 

  • Moster, D., Lie, R., & Markestad, T. (1999). Relation between size of delivery unit and neonatal death in low risk deliveries: Population based study. Archives of Disease in Childhood. Fetal and Neonatal Edition, 80, F221–F225.

    Article  CAS  PubMed  Google Scholar 

  • Pediatrix Medical Group. (n.d.). Retrieved August 22, 2007, from http://www.pediatrix.com/.

  • Perkins, B. B. (2004). Perinatal regionalization and economic order. In The medical delivery business: Health reform, childbirth and the economic order (pp. 85–100). New Brunswick, NJ and London: Rutgers University Press.

    Google Scholar 

  • Phibbs, C. S., Baker, L. C., Caughey, A. B., Danielsen, B., Schmitt, S. K., & Phibbs, R. H. (2007). Level and volume of neonatal intensive care and mortality in very-low-birth-weight infants. New England Journal of Medicine, 356(21), 2165–2175.

    Article  CAS  PubMed  Google Scholar 

  • Phibbs, C., Bronstein, J., Buxton, E., & Phibbs, R. (1996). The effects of patient volume and level of care at the hospital of birth on neonatal mortality. Journal of the American Medical Association, 276, 1053–1059.

    Article  Google Scholar 

  • Pollack, L. D., Ratner, I. M., & Lund, G. C. (1998). United States neonatology practice survey: Personnel, practice, hospital and neonatal intensive care unit characteristics. Pediatrics, 101, 398–405.

    Article  CAS  PubMed  Google Scholar 

  • Powell, S., Holt, V., Hickok, D., Easterling, T., & Connell, F. (1995). Recent changes in delivery site of low-birth-weight infants in Washington: Impact on birth weight-specific mortality. American Journal of Obstetrics and Gynecology, 173, 1585–1592.

    Article  CAS  PubMed  Google Scholar 

  • Richardson, D. K., Gray, J. E., Gortmaker, S. L., Goldmann, D. A., Pursley, D. M., & McCormick, M. C. (1998). Declining severity adjusted mortality: Evidence of improving neonatal intensive care. Pediatrics, 102(4 Pt 1), 893–899.

    Article  CAS  PubMed  Google Scholar 

  • Richardson, D. K., Reed, K., Cutler, J. C., Boardman, R. C., Goodman, K., Moynihan, T., et al. (1995). Perinatal regionalization versus hospital competition: The Hartford example. Pediatrics, 96(3 Pt 1), 417–423.

    CAS  PubMed  Google Scholar 

  • Rogowski, J. A., Staiger, D. O., & Horbar, J. D. (2004). Variations in the quality of care for very-low-birthweight infants: Implications for policy. Health Affairs (Millwood), 23(5), 88–97.

    Article  Google Scholar 

  • Rosenblatt, R., Macfarlane, A., Dawson, A., Cartilidge, P., Larson, E., & Hart, L. (1996). The regionalization of perinatal care in Wales and Washington State. American Journal of Public Health, 86, 1011–1015.

    Article  CAS  PubMed  Google Scholar 

  • Schwartz, R. M., Muri, J. H., Overpeck, M. D., Pezzullo, J. C., & Kogan, M. D. (2000). Use of high-technology care among women with high-risk pregnancies in the United States. Maternal and Child Health Journal, 4(1), 7–18.

    Article  CAS  PubMed  Google Scholar 

  • Sinkin, R., Fisher, S., Dozier, A., & Dye, T. (2005). Effect of managed care on perinatal transports for the publicly funded in upstate New York. Journal of Perinatology, 25, 79–85.

    Article  PubMed  Google Scholar 

  • The Vermont Oxford Network. (n.d.). Retrieved August 24, 2007, from http://www.vtoxford.org/.

  • Thompson, L. A., Goodman, D. C., & Little, G. A. (2002). Is more neonatal intensive care always better? Insights from a cross-national comparison of reproductive care. Pediatrics, 109(6), 1036–1043.

    Article  PubMed  Google Scholar 

  • U.S. Department of Health and Human Services. Healthy People 2010. (n.d.). Retrieved August 22, 2007, from http://www.healthypeople.gov/.

  • Wall, S., Handler, A., & Park, C. (2004). Hospital factors and nontransfer of small babies: A marker of deregionalized perinatal care? Journal of Perinatology, 24(6), 351–359.

    Article  PubMed  Google Scholar 

  • Yeast, J., Poskin, M., Stockbauer, J., & Shaffer, S. (1998). Changing patterns in regionalization of perinatal care and the impact on neonatal mortality. American Journal of Obstetrics and Gynecology, 178(1), 131–135.

    Article  CAS  PubMed  Google Scholar 

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Thompson, L.A., Goodman, D.C. (2011). Regionalized Perinatal Care: An Evidence-Based Intervention in Development. In: Handler, A., Kennelly, J., Peacock, N. (eds) Reducing Racial/Ethnic Disparities in Reproductive and Perinatal Outcomes. Springer, Boston, MA. https://doi.org/10.1007/978-1-4419-1499-6_17

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