Population‐based cohort study of hospital delivery volume, geographic accessibility, and obstetric outcomes. Issue 1 (17th May 2019)

• Record Type: Journal Article
• Authors: Aubrey‐Bassler, F. Kris; Cullen, Richard M.; Simms, Alvin; Asghari, Shabnam; Crane, Joan; Wang, Peizhong P.; Godwin, Marshall
• Is Part Of: International journal of gynaecology and obstetrics. Volume 146:Issue 1(2019)
• Page Start: 95
• Page End: 102
• Publication Date: 2019-05-17
• Subjects: Health services accessibility -- High‐volume hospitals -- Low‐volume hospitals -- Perinatal mortality -- Pregnancy complications -- Rural health services; Gynecology -- Periodicals; Obstetrics -- Periodicals; Electronic journals; 618
• DOI: 10.1002/ijgo.12832
• Languages: English
• ISSNs: 0020-7292

Abstract

Abstract: Objective: To determine associations between geographic accessibility, delivery volume, and obstetric outcomes. Methods: Population‐based cohort study of linked hospital administrative, census, and geospatial data (2006–2009) from all Canadian jurisdictions except Quebec. Perinatal mortality and major maternal morbidity/mortality were compared across categories of road distance and hospital delivery volume. Results: Among 820 761 mothers delivering 827 504 neonates, travel distance had minimal effect on perinatal mortality. Compared with mothers travelling 0–9 km, the odds of adverse maternal outcomes was decreased for women travelling modest distances (20–49 km, odds ratio, 0.80 [95% confidence interval, 0.75–0.86]), and increased thereafter (50–99 km, 0.99 [0.89–1.10]; 200–299 km, 1.44 [1.10–1.87]; >400 km, 2.22 [1.06–4.63]). Relative to high‐volume hospitals (>2500 deliveries/year), adverse maternal outcomes were less likely for hospitals with 1000–2499 (0.90 [0.86–0.95]), and roughly equivalent for hospitals with 200–499 (1.34 [1.22–1.48]) and 500–999 (1.27 [1.17–1.39]) deliveries/year. Odds of perinatal mortality ranged from 1.04 (0.73–1.49; 100–199 deliveries/year) to 1.50 (1.04–2.16; 50–99 deliveries/year); the pattern did not suggest causality. Conclusion: Maternal outcomes worsen when travel distance is greater than 200 km, and improve when delivery volume exceeds 1000 deliveries per year. Abstract : In a population‐based analysis, delivery volume and geographic accessibility were found to be associated with differences in maternal obstetric outcomes, but not perinatal mortality.