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Strengthening the evidence for maternal and child health programs

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Displaying records 1 through 11 (11 total).

Bronstein JM, Ounpraseuth S, Jonkman J, et al. Improving perinatal regionalization for preterm deliveries in a Medicaid covered population: initial impact of the Arkansas ANGELS intervention. Health Serv Res. 2011;46(4):1082-1103.

Link: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3165179/

NPM: 3: Perinatal Regionalization
Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Access to Provider through Hotline, HOSPITAL, Continuing Education of Hospital Providers, POPULATION-BASED SYSTEMS, INTER-HOSPITAL SYSTEMS, Maternal/In-Utero Transport Systems, Consultation Systems, Telemedicine Systems, STATE, Policy/Guideline (State)

Intervention Results:

Any hospital with NICU:
  • Although the change in percent of infants <35 weeks GA delivered at any hospital with NICU was statistically significant (p<0.01), the early increases in delivery seen in these hospitals after intervention in 2003 were lost after further follow-up. Over the study period, the percent of infants <35 weeks GA delivered at any hospital with NICU increased from 37.7% before intervention to a high of 44.1% in the year after intervention then subsequently decreased to 39.1% by then end of the follow-up period.
  • No ANGELS intervention components were statistically significantly associated with delivery at any NICU hospital (p>0.05).

UAMS (tertiary center):

  • Although the change in percent of infants <35 weeks GA delivered at UAMS was statistically significant (p<0.001), the early gains seen in percent delivered in the tertiary center appeared to be lost after further follow-up. Over the study period, the percent of infants <35 weeks GA delivered at UAMS tertiary center increased from 20.6% before intervention to a high of 27.3% in in the year after intervention then subsequently decreased to 19.6% by the end of the follow-up period.
  • Women living in counties with hospitals that participated in teleconferences on high-risk obstetrics with University of Arkansas for Medical Science (UAMS; an ANGELS program component) were more likely to deliver at UAMS (odds ratio (OR): 1.64, 95%; CI: 1.17 to 2.30; p=0.004). No other ANGELS program component was statistically significantly associated with an increased likelihood of delivery at UAMS (p>0.05).

Hall RW, Hall-Barrow J, Garcia-Rill E. Neonatal regionalization through telemedicine using a community-based research and education core facility. Ethn Dis. 2010;20(1 0 1):S1-136-140.

Link: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3323108/

NPM: 3: Perinatal Regionalization
Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Access to Provider through Hotline, HOSPITAL, Continuing Education of Hospital Providers, POPULATION-BASED SYSTEMS, INTER-HOSPITAL SYSTEMS, Maternal/In-Utero Transport Systems, Consultation Systems, Telemedicine Systems, STATE, Policy/Guideline (State)

Intervention Results:

All LBW:

  • After the intervention, the case mix-adjusted probability of UAMS tertiary center delivery increased by 7.2% (p<0.05) among all LBW infants.
  • After the intervention, the percentage of non-NICU hospital births among all LBW births was over 50% and was not significantly different than before intervention (p-value not indicated).
  • Among all LBW infants, there was little change in birth location distribution after intervention. The percentage born in community hospitals with NICU decreased slightly from 30.1% to 28.8%. The percentage born in UAMS tertiary center was around 18% both before and after the intervention. The authors do not comment on statistical significance of these results.

ELBW:

  • Among all ELBW infants, there was little change in the birth location distribution. Of all ELBW infants, about 42% were born at UAMS tertiary center both before and after intervention. The percentage born in community hospitals with NICU decreased slightly from 35.3% to 30.7%. Data was not presented for births in non-NICU hospitals. The authors do not comment on statistical significance of these results.

ELBW subgroup:

  • After intervention, the case mix-adjusted probability of UAMS tertiary center delivery increased from 27.6% to 34.5% (p<0.01) among ELBW births to mothers residing more than 80 miles from UAMS.
  • Among ELBW infants born to mothers residing more than 80 miles from UAMS, there were some changes in birth location distribution. Of these infants, the percentage born in UAMS tertiary center increased from 40.7% to 46.8% after intervention. The percentage born in community hospital with NICU decreased from 26.8% to 17.5%. However, the percentage of non-NICU hospital births among this group increased from 32.5% to 35.7%. The authors do not comment on the statistical significance of these results.

Nugent RR. Perinatal regionalization in North Carolina, 1967-1979: services, programs, referral patterns, and perinatal mortality rate declines for very low birthweight infants. N C Med J. 1982;43(7):513-515.

Link: https://www.ncbi.nlm.nih.gov/pubmed/6956811

NPM: 3: Perinatal Regionalization
Intervention Components (click on component to see a list of all articles that use that intervention): HOSPITAL, Development/Improvement of Services, Continuing Education of Hospital Providers, Needs Assessment, POPULATION-BASED SYSTEMS, STATE, Policy/Guideline (State), Funding Support, Perinatal Committees/Councils, Increased Reimbursement

Intervention Results:

Among all VLBW infants, there was a change in birth location distribution. Of these infants, the percentage born in level III hospitals increased from 25.7% in period one to 46.8% in period four. The percentage born in level II hospitals decreased from 41.7% to 36% and the percentage born in level I also decreased from 32.6% to 17.2%. The authors do not comment on the statistical significance of these results.

Powers WF, McGill L. Perinatal market penetration rate. A tool to evaluate regional perinatal programs. Am J Perinatol. 1987;4(1):24-28.

Link: https://www.ncbi.nlm.nih.gov/pubmed/3790214

NPM: 3: Perinatal Regionalization
Intervention Components (click on component to see a list of all articles that use that intervention): HOSPITAL, Continuing Education of Hospital Providers, STATE, Policy/Guideline (State)

Intervention Results:

During all but one of nine post-intervention years, the percentage of regional VLBW births delivered in level III hospitals was statistically significantly higher than what would have been expected had it been the same as the percentage of all regional births delivered at level III hospitals (p<0.001). This suggests that VLBW births compromise a larger percentage of total births at level III hospitals than would be expected if they followed the same birth location distribution as all infants in the region.

Bowes WA, Jr. A review of perinatal mortality in Colorado, 1971 to 1978, and its relationship to the regionalization of perinatal services. Am J Obstet Gynecol. 1981;141(8):1045-1052.

Link: https://www.ncbi.nlm.nih.gov/pubmed/7315916

NPM: 3: Perinatal Regionalization
Intervention Components (click on component to see a list of all articles that use that intervention): HOSPITAL, Continuing Education of Hospital Providers, POPULATION-BASED SYSTEMS, STATE, Policy/Guideline (State), Funding Support, Perinatal Committees/Councils

Intervention Results:

The proportion of VLBW births among total births in each hospital level shifted between the pretest and posttest period. In level III hospitals, the proportion of VLBW births among total births rose from 2.8% to 4.8% (p<0.05). In level II hospitals, the proportion of VLBW births among total births stayed the same (1.9%). In level I hospitals, there was a decrease from 1.6% to 1.1% of total births.

Campbell MK, Chance GW, Natale R, Dodman N, Halinda E, Turner L. Is perinatal care in southwestern Ontario regionalized? CMAJ. 1991;144(3):305-312.

Link: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1452689/

NPM: 3: Perinatal Regionalization
Intervention Components (click on component to see a list of all articles that use that intervention): HOSPITAL, Continuing Education of Hospital Providers, POPULATION-BASED SYSTEMS, INTER-HOSPITAL SYSTEMS, Maternal/In-Utero Transport Systems, Follow-Up Given On Transferred Patients, STATE, Perinatal Committees/Councils, NICU Bed Registry/Electronic Bulletin Board

Intervention Results:

  • Among all women admitted to level I or II hospitals, the percentage of maternal transfer to level III hospitals increased from 2.2% of all admitted women (262 women) to 2.8% (p<0.003) after the intervention.
  • Among all women admitted to level I or II hospitals, maternal transfer of those with labor or threatened preterm labor before 37 weeks gestation to level III hospitals increased by 38% from 0.72% of all admitted women to 0.99% after intervention (p=0.024).
  • Among all infants born at 500-1499 gm, there was a statistically significant change in distribution of the number born in level III hospitals after intervention (p<0.001)

Hein HA. Evaluation of a rural perinatal care system. J Pediatr. 1980;66(4):540-546.

Link: http://pediatrics.aappublications.org/content/66/4/540

NPM: 3: Perinatal Regionalization
Intervention Components (click on component to see a list of all articles that use that intervention): HOSPITAL, Development/Improvement of Services, Continuing Education of Hospital Providers, Needs Assessment, POPULATION-BASED SYSTEMS, INTER-HOSPITAL SYSTEMS, Maternal/In-Utero Transport Systems, Agreement for Level III Hospital to Accept All Patients, Perinatal Committees/Councils, STATE

Intervention Results:

  • The intervention in Iowa focused on increasing both level III and level II VLBW births due to population density concerns in Iowa.
  • Among all VLBW infants, there were changes in the birth location distribution. Of these infants, there was a statistically significant increase in percentage born in level III hospitals from 6.7% to 22.6% (p<0.05)1 and an increase in births in level II hospitals from 26.9% to 35.6%. The percentage born in level I centers decreased from 68.2% to 41.8%.

Hein HA, & Burmeister LF. The effect of ten years of regionalized perinatal health care in Iowa, U.S.A. Eur J Obstet Gynecol Reprod Biol. 1986;21(1):33-48.

Link: https://www.ncbi.nlm.nih.gov/pubmed/3956827

NPM: 3: Perinatal Regionalization
Intervention Components (click on component to see a list of all articles that use that intervention): HOSPITAL, Development/Improvement of Services, Continuing Education of Hospital Providers, Needs Assessment, POPULATION-BASED SYSTEMS, INTER-HOSPITAL SYSTEMS, Maternal/In-Utero Transport Systems, Agreement for Level III Hospital to Accept All Patients, STATE, Funding Support, Perinatal Committees/Councils

Intervention Results:

  • The intervention in Iowa focused on increasing both level III and level II VLBW births due to population density concerns in Iowa.
  • Among all VLBW infants, there was a statistically significant change in the distribution of VLBW births (p<0.001). Of these infants, there was an increase in percentage born in level III hospitals from 6.7% to 35.3% and an increase in level II hospitals from 30.6% to 42.9%. The percentage born in level I centers decreased from 62.7% to 21.8%.

Lessaris KJ, Annibale DJ, Southgate WM, Hulsey TC, Ohning BL. Effects of changing health care financial policy on very low birthweight neonatal outcomes. South Med J. 2002;95(4):426-430.

Link: https://www.ncbi.nlm.nih.gov/pubmed/11958241

NPM: 3: Perinatal Regionalization
Intervention Components (click on component to see a list of all articles that use that intervention): Increased Reimbursement, STATE, POPULATION-BASED SYSTEMS

Intervention Results:

The overall birth location distribution of VLBW births did not significantly change after intervention (p=0.375).

McCormick MC, Shapiro S, Starfield BH. The regionalization of perinatal services. Summary of the evaluation of a national demonstration program. JAMA. 1985;253(6):799-804.

Link: https://jamanetwork.com/journals/jama/fullarticle/396757

NPM: 3: Perinatal Regionalization
Intervention Components (click on component to see a list of all articles that use that intervention): HOSPITAL, Development/Improvement of Services, Continuing Education of Hospital Providers, POPULATION-BASED SYSTEMS, INTER-HOSPITAL SYSTEMS, Maternal/In-Utero Transport Systems, Consultation Systems, STATE, Policy/Guideline (State), Funding Support

Intervention Results:

  • Among all VLBW infants in intervention regions, there was a shift towards increasing births in tertiary centers from 35.72% in the pretest period to 47.3% at the time of intervention to 59.4% in the posttest period.
  • Among all VLBW infants in comparison regions, there was also a shift towards increasing births in tertiary centers from 29.67% in the pre-test period to 34.2% at the time of intervention to 47.19% in the posttest period.
  • The authors do not comment on the statistical significance of these results. However, the authors do note that the difference in the rate of centralization of births in tertiary centers was not “strikingly greater” in the intervention regions as compared with the comparison regions.

Nowakowski, L., Barfield, W. D., Kroelinger, C. D., Lauver, C. B., Lawler, M. H., White, V. A., & Ramos, L. R. (2012). Assessment of state measures of risk-appropriate care for very low birth weight infants and recommendations for enhancing regionalized state systems. Maternal and child health journal, 16(1), 217-227.

Link: https://doi.org/10.1007/s10995-010-0721-5

NPM: 3: Perinatal Regionalization
Intervention Components (click on component to see a list of all articles that use that intervention): STATE, Policy/Guideline (State), Funding Support, POPULATION-BASED SYSTEMS, Telemedicine Systems, PATIENT/CONSUMER, Educational Material

Intervention Results:

Regulation of regionalization programs, data surveillance, review of adverse events, and consideration of geography and demographics were identified as mechanisms facilitating better measurement of risk-appropriate care. Antenatal or neonatal transfer arrangements, telemedicine networks, acquisition of funding, provision of financial incentives, and patient education comprised state actions for improving risk-appropriate care.
   

This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number U02MC31613, MCH Advanced Education Policy, $3.5 M. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.