title: Access to obstetric care in rural areas: effect on birth outcomes.
abstract: Hospital discharge data from 33 rural hospital service areas in Washington State were categorized by the extent to which patients left their local communities for obstetrical services. Women from communities with relatively few obstetrical providers in proportion to number of births were less likely to deliver in their local community hospital than women in rural communities with greater numbers of physicians practicing obstetrics in proportion to number of births. Women from these high-outflow communities had a greater proportion of complicated deliveries, higher rates of prematurity, and higher costs of neonatal care than women from communities where most patients delivered in the local hospital.
authors.affiliation: Department of Family Practice, University of California, Davis, Sacramento 95817.
authors.forename: T S
authors.initials: TS
authors.lastname: Nesbitt
authors.forename: F A
authors.initials: FA
authors.lastname: Connell
authors.forename: L G
authors.initials: LG
authors.lastname: Hart
authors.forename: R A
authors.initials: RA
authors.lastname: Rosenblatt
mesh_terms: D000293:Adolescent; D000328:Adult; D003365:Costs and Cost Analysis; D003627:Data Interpretation, Statistical; D005249:Fees and Charges; D005260:Female; D006297:Health Services Accessibility; D006764:Hospitals, Community / Q000706:statistics & numerical data; D006801:Humans; D007224:Infant Care / Q000191:economics; D007231:Infant, Newborn; D008427:Maternal Health Services / Q000600:supply & distribution*; D011247:Pregnancy; D011256:Pregnancy Outcome; D012424:Rural Population; D014861:Washington