Premium
The Impact of Obstetric Unit Closures on Maternal and Infant Pregnancy Outcomes
Author(s) -
Lorch Scott A.,
Srinivas Sindhu K.,
Ahlberg Corinne,
Small Dylan S.
Publication year - 2013
Publication title -
health services research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.706
H-Index - 121
eISSN - 1475-6773
pISSN - 0017-9124
DOI - 10.1111/j.1475-6773.2012.01455.x
Subject(s) - medicine , odds ratio , pregnancy , obstetrics , unit (ring theory) , pediatrics , genetics , mathematics education , mathematics , pathology , biology
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 J anuary 1, 1995 and J une 30, 2005 in P hiladelphia, 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 P hiladelphia 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.