Details

Autor(en) / Beteiligte

• Brantley, Mary D., MPH
• Davis, Nicole L., PhD, MPH
• Goodman, David A., PhD, MS
• Callaghan, William M., MD, MPH
• Barfield, Wanda D., MD, MPH, FAAP

Titel

Perinatal Regionalization: A Geospatial View of Perinatal Critical Care, United States, 2010-2013

Ist Teil von

• American journal of obstetrics and gynecology, 2017-02, Vol.216 (2), p.185.e1-185.e10

Ort / Verlag

United States: Elsevier Inc

Erscheinungsjahr

2017

Link zum Volltext

Quelle

MEDLINE

Beschreibungen/Notizen

• Abstract Background Perinatal services exist today as a dyad of maternal and neonatal care. When perinatal care is fragmented or unavailable, excess morbidity and mortality may occur in pregnant women and newborns. Objective Describe spatial relationships between women of reproductive age, individual perinatal subspecialists (Maternal Fetal Medicine and Neonatology), and obstetric and neonatal critical care facilities in the United States to identify gaps in health care access. Study Design We used geographic visualization and conducted surface interpolation, nearest neighbor, and proximity analyses. Source data included 2010 United States Census, October 2013 National Provider Index, 2012 American Hospital Association, 2012 National Center for Health Statistics Natality File, and the 2011 American Academy of Pediatrics Directory. Results In October 2013, there were 2.5 neonatologists for every Maternal Fetal Medicine specialist in the United States. In 2012 there were 1.4 Level III or higher neonatal intensive care units (NICU) for every Level III obstetric unit (hereafter, obstetric critical care unit). Nationally, 87% of women of reproductive age live within 50 miles of both an obstetric critical care unit and NICU. However, 18% of obstetric critical care units had no NICU and 20% of NICUs had no obstetric critical care unit within a 10 mile radius. Additionally, 26% of obstetric critical care units had no Maternal Fetal Medicine specialist practicing within 10 miles of the facility and 4% of NICUs had no neonatologist practicing within 10 miles. Conclusion Gaps in access and discordance between the availability of Level III or higher obstetric and neonatal care may affect delivery of risk appropriate care for high risk maternal fetal dyads. Further study is needed to understand the importance of these gaps and discordance on maternal and neonatal outcomes.