Skip Navigation

Strengthen the Evidence for Maternal and Child Health Programs

Find Established Evidence


Displaying records 1 through 20 (25 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, STATE, Policy/Guideline (State), Consultation Systems (Inter-Hospital Systems), Consultation Systems (Hospital), Telemedicine Systems (Inter-Hospital Systems), Telemedicine Systems (Hospital)

Intervention Results:

Perceived risk, age, education, and prenatal care characteristics of women affected the likelihood of use of the NICU. The perceived availability of local expertise was associated with a lower likelihood that preterm infants would deliver at the NICU. ANGELS did not increase the overall use of NICU, but it did shift some deliveries to the academic setting.

Cowett RM, Coustan DR, Oh W. Effects of maternal transport on admission patterns at a tertiary care center. Am J Obstet Gynecol. 1986;154(5):1098-1100.

Link: https://www.ncbi.nlm.nih.gov/pubmed/3706436

NPM: 3: Perinatal Regionalization
Intervention Components (click on component to see a list of all articles that use that intervention): Development/Improvement of Services, HOSPITAL

Intervention Results:

The number of maternal transports to the level III hospital increased from 65 before intervention to 280 after intervention. This was accompanied by a corresponding increase in number of infants admitted to the NICU who were born to transferred women from 43 before intervention to 201 after intervention, suggesting some of the increase in maternal transfer was due to anticipated neonatal care needs. The authors do not comment on statistical significance of this result.

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 (Inter-Hospital Systems), Consultation Systems (Hospital), Telemedicine Systems (Inter-Hospital Systems), Telemedicine Systems (Hospital), STATE, Policy/Guideline (State)

Intervention Results:

Medicaid deliveries at the regional perinatal centers increased from 23.8% before the intervention to 33% in neonates between 500 and 999 grams (p<0.05) and was unchanged in neonates between 2001-2500 grams.

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:

An Illinois center's annual penetration rate into its regional market for the years 1973-1983 is presented and significant increases are found. The penetration rates of nine Illinois perinatal centers are calculated and wide discrepancies are found. Defining a high-risk regional cohort as a market stresses a perinatal center's obligation to its region.

Tomich PG, Anderson CL. Analysis of a maternal transport service within a perinatal region. Am J Perinatol. 1990;7(1):13-17.

Link: https://www.ncbi.nlm.nih.gov/pubmed/2294904

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

Intervention Results:

Analysis of perinatal statistics from the Loyola University Perinatal Center from 1979 to 1986 supports: (1) increasing numbers of maternal and neonatal transports, with the number of maternal transports exceeding the number of neonatal transports since 1982; (2) increasing proportion of low birthweight and very low birthweight infants delivered at the perinatal center; (3) a decrease in the number of infants less than 1500 gm sent as neonatal transports; and (4) increasing proportion of neonatal transports with a birthweight greater than 2500 gm.

Vendittelli F, Riviere O, Crenn-Hebert C, Giraud-Roufast A. Do perinatal guidelines have an impact on obstetric practices? Rev Epidemiol Sante Publique. 2012;60(5):355-362.

Link: https://www.ncbi.nlm.nih.gov/pubmed/22981161

NPM: 3: Perinatal Regionalization
Intervention Components (click on component to see a list of all articles that use that intervention): Policy/Guideline (National), NATIONAL, POPULATION-BASED SYSTEMS

Intervention Results:

The percentage of children weighing less than 1500 g at birth born in Level III hospitals increased through 1999 but dropped subsequently, without ever returning to the 1994 level (P<0.0001). The overall caesarean rate climbed slowly but regularly from 1994 through 2006 (P<0.0001). Use of antenatal corticosteroids for women hospitalised for threatened preterm labour and in children born before 33 weeks has fluctuated since the release of the guideline (P>0.05). Exclusive breastfeeding at discharge from the maternity ward has increased slowly (P<0.0001). The percentage of deliveries with active management of the third stage of labour rose notably from 1999 to 2006 (P<0.0001), and smoking cessation during pregnancy rose slightly in 2006 (P<0.0001). Since 1994, early discharges have become slowly, slightly, but regularly more frequent for all women (P<0.0001). The guideline on episiotomies has had a slight positive effect in the short term (P<0.0001).

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:

There has been a decrease in neonatal mortality rate from 13.4 to 6.9 during a period of time when there was a minimal decrease in the incidence of low-birth weight infants. The improved neonatal mortality has been associated with a shift in the frequency of birth of very low-birth weight (VLBW) infants to hospitals with level II and III perinatal services and relatively greater survival rates of VLBW infants born in these hospitals as compared to those born in level I hospitals. There was no decrease in fetal mortality in the same period of time.

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:

Between 1982 and 1985 the antenatal transfer rate increased from 2.2% to 2.8% (p less than 0.003). The proportion of births of infants weighing 500 to 1499 g increased from 49% to 69% at the level III hospital. The neonatal transfer rate increased from 26.2% to 47.9% (p less than 0.05) for infants in this birth-weight category and decreased from 10.2% to 7.1% (p less than 0.03) for infants weighing 1500 to 2499 g. The death rate among infants of low birth weight was lowest among those born at the level III centre and decreased at all centres between 1982 and 1985.

Gale C, Santhakumaran S, Nagarajan S, Statnikov Y, Modi N. Impact of managed clinical networks on NHS specialist neonatal services in England: population based study. BMJ. 2012;344:e2105.

Link: https://www.ncbi.nlm.nih.gov/pubmed/22490978

NPM: 3: Perinatal Regionalization
Intervention Components (click on component to see a list of all articles that use that intervention): Reorganization of Neonatal Services, NATIONAL, POPULATION-BASED SYSTEMS

Intervention Results:

After reorganisation, there were increases in the proportions of babies born at 27-28 weeks' gestation in hospitals providing the highest volume of neonatal specialist care (18% (631/3495) v 49% (1325/2724); odds ratio 4.30, 95% confidence interval 3.83 to 4.82; P<0.001) and in acute and late postnatal transfers (7% (235) v 12% (360) and 18% (579) v 22% (640), respectively; P<0.001). There was no significant change in the proportion of babies from multiple births separated by transfer (33% (39) v 29% (38); 0.86, 0.50 to 1.46; P=0.57). In epoch two, 32% of acute transfers were to a neonatal unit providing either an equivalent (n=87) or lower (n=26) level of specialist care.

Victorian Infant Collaborative Study Group (VICSG). Improvement of outcome for infants of birth weight under 1000 g. Arch Dis Child. 1991;66:765-769.

Link: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1590220/

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

Intervention Results:

Among all ELBW infants, the percentage of non-level III hospital births statistically significantly decreased after intervention from 30.2% to 23.0% (OR: 0.69, 95% CI: 0.51 to 0.93, p=0.02).

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:

Level I hospitals currently manage low-risk patients and report very low mortality rates. Level II facilities receive high-risk referrals, but selective referral occurs since the tertiary center accounts for a disproportionate number of fetal and neonatal deaths, and births weighting less than 1500 g.

Hoekstra R, Fangman, J., Perkett, E., Brasel, D., & Knox, G.E. Regionalization of Perinatal Care: Results of a Cooperative Community Based Program. Minn Med. 1981;64(10):637-640.

Link: https://www.ncbi.nlm.nih.gov/pubmed/6801450

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, Peer-Review of Provider Decisions, POPULATION-BASED SYSTEMS, INTER-HOSPITAL SYSTEMS, Maternal/In-Utero Transport Systems, Consultation Systems (Inter-Hospital Systems), Consultation Systems (Hospital), Agreement for Level III Hospital to Accept All Patients, Medical Staff Integration

Intervention Results:

After the intervention, there was a statistically significant decrease in the number of VLBW infants born in a level II hospital (p<0.01).

Kim EW, Teague-Ross TJ, Greenfield WW, Keith Williams D, Kuo D, Hall RW. Telemedicine collaboration improves perinatal regionalization and lowers statewide infant mortality. J Perinatol. 2013;33(9):725-730.

Link: https://www.ncbi.nlm.nih.gov/pubmed/23579490

NPM: 3: Perinatal Regionalization
Intervention Components (click on component to see a list of all articles that use that intervention): Transition Assistance, PATIENT/CONSUMER, HOSPITAL, Continuing Education of Hospital Providers, POPULATION-BASED SYSTEMS, INTER-HOSPITAL SYSTEMS, Neonatal Back-Transport Systems, Consultation Systems (Inter-Hospital Systems), Consultation Systems (Hospital), Telemedicine Systems (Inter-Hospital Systems), Telemedicine Systems (Hospital)

Intervention Results:

Deliveries of VLBW neonates in targeted hospitals decreased from 13.1 to 7.0% (P=0.0099); deliveries of VLBW neonates in remaining hospitals were unchanged. Mortality decreased in targeted hospitals (13.0% before TM and 6.7% after TM). Statewide infant mortality decreased from 8.5 to 7.0 per 1000 deliveries (P=0.043).

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:

A decrease in the proportion of nonwhite very low birthweight infants was identified. There was an increase in very low birthweight infants with Medicaid funding born outside our level III center.

Lui K, Abdel-Latif ME, Allgood CL, et al. Improved outcomes of extremely premature outborn infants: effects of strategic changes in perinatal and retrieval services. J Pediatr. 2006; 2006 Nov; 118(5):2076-2083.

Link: https://www.ncbi.nlm.nih.gov/pubmed/17079581

NPM: 3: Perinatal Regionalization
Intervention Components (click on component to see a list of all articles that use that intervention): Maternal/In-Utero Transport Systems, INTER-HOSPITAL SYSTEMS, POPULATION-BASED SYSTEMS, Consultation Systems (Inter-Hospital Systems), Perinatal Committees/Councils, NICU Bed Registry/Electronic Bulletin Board

Intervention Results:

There were 25% fewer nontertiary hospital live births (19.7% vs 14.9%) and more prenatal steroid use. Despite an 11.4% average annual increase in NICU admissions between the 2 epochs, fewer infants were outborn (12.0% vs 9.3%) and outborn mortality rates decreased significantly (39.4% vs 25.1%), particularly for those between 27 and 28 weeks of gestation. The overall improvement was equivalent to 1 extra survivor per 16 New South Wales births. There were also significantly fewer serious outcome morbidities in outborn infants during epoch 2, over the improvements in inborn infants.

Warner B, Altimier L, Imhoff S. Clinical excellence for high risk neonates: improved perinatal regionalization through coordinated maternal and neonatal transport. Neonatal Intensive Care. 2002;15(6):33-38.

Link: https://www.researchgate.net/publication/272023854_Clinical_Excellence_for_High-Risk_NeonatesImproved_Perinatal_Regionalization_through_Coordinated_maternal_and_Neonatal_Transport

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, Peer-Review of Provider Decisions, POPULATION-BASED SYSTEMS, INTER-HOSPITAL SYSTEMS, Neonatal Back-Transport Systems, Medical Staff Integration

Intervention Results:

There was a significant decrease of 63% in the number of VLBW births at level II hospital after intervention (p-value and statistical test not indicated). The annual number of maternal transports to level III hospital increased 258% after intervention from an average of 38 per year to 98. The authors do not comment on statistical significance of this result.

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 (Inter-Hospital Systems), Consultation Systems (Hospital), STATE, Policy/Guideline (State), Funding Support

Intervention Results:

In both funded regions and comparison areas, the neonatal mortality rates decreased sharply over the decade of the 1970s. This decline was linked to shifts in the hospital of delivery that indicated antepartum risk identification and transfer of management of high-risk pregnancies to tertiary centers for delivery, a change in service pattern consistent with some aspects of regionalization. The centralization of high-risk deliveries appeared so widespread that the special effect of the RWJF program could not be detected.

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://link.springer.com/article/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, 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.
    Next Page »

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.