Document Detail

The impact of obstetric unit closures on maternal and infant pregnancy outcomes.
MedLine Citation:
PMID:  22881056     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: To define the association between large-scale obstetric unit closures and relative changes in maternal and neonatal outcomes.
DATA SOURCES/STUDY SETTING: Birth and death certificates were linked to maternal and neonatal hospital discharge records for all births between January 1, 1995 and June 30, 2005 in Philadelphia, which experienced the closure of 9 of 19 obstetric units between 1997 and 2005, and five surrounding counties and eight urban counties that did not experience a similar reduction in obstetric units.
DESIGN: A before-and-after study design with an untreated control group compared changes in perinatal outcomes in Philadelphia to five surrounding control counties and eight urban control counties after controlling for case mix differences and secular trends (N = 3,140,782).
RESULTS: Relative to the preclosure years, the difference in neonatal mortality (odds ratio (OR) 1.49, 95 percent CI 1.12-2.00) and all perinatal mortality (OR 1.53, 95 percent CI 1.14-2.04) increased for Philadelphia residents compared with both control groups between 1997 and 1999. After 2000, there was no statistically significant change in any outcome in Philadelphia county compared with the preclosure epoch.
CONCLUSIONS: Obstetric unit closures were initially associated with adverse changes in perinatal outcomes, but these outcomes ameliorated over time.
Scott A Lorch; Sindhu K Srinivas; Corinne Ahlberg; Dylan S Small
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural     Date:  2012-08-10
Journal Detail:
Title:  Health services research     Volume:  48     ISSN:  1475-6773     ISO Abbreviation:  Health Serv Res     Publication Date:  2013 Apr 
Date Detail:
Created Date:  2013-03-13     Completed Date:  2013-05-06     Revised Date:  2014-04-02    
Medline Journal Info:
Nlm Unique ID:  0053006     Medline TA:  Health Serv Res     Country:  United States    
Other Details:
Languages:  eng     Pagination:  455-75     Citation Subset:  IM    
Copyright Information:
© Health Research and Educational Trust.
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MeSH Terms
Cesarean Section / statistics & numerical data
Health Facility Closure / statistics & numerical data*
Health Services Research
Hospital Administration / statistics & numerical data*
Hospital Bed Capacity
Infant Mortality*
Infant, Newborn
Intensive Care Units, Neonatal / organization & administration,  statistics & numerical data
Obstetrics and Gynecology Department, Hospital / statistics & numerical data*
Outcome Assessment (Health Care)
Outcome and Process Assessment (Health Care)
Philadelphia / epidemiology
Pregnancy Complications / epidemiology
Pregnancy Outcome / epidemiology*
Premature Birth / epidemiology
Socioeconomic Factors
Grant Support

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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