Differential markers for regionalization.
OBJECTIVE
To examine the site of delivery for very low birth weight (VLBW) infants and infants with major congenital malformations (MCM) within an established system of perinatal regionalization.


METHODS
A retrospective study of site of delivery for VLBW infants and infants born with MCM (tracheoesophageal fistula/esophageal atresia, diaphragmatic hernia, or gastroschisis/omphalocele) from 1990 through 1995 in Ohio.


RESULTS
A total of 59.8% of VLBW infants and 36.1% of MCM infants were born in a level III hospital. There was a significant trend toward a decrease in VLBW infants (p < 0.01) and an increase in MCM infants (p < 0.05) born in a level III hospital between 1990 and 1995. There were significant regional variations among the six perinatal regions in Ohio in the proportion of both VLBW and MCM infants born in a tertiary center.


CONCLUSIONS
Using the traditional marker of VLBW to assess regionalization in one state, we found significant variation in site of delivery among the perinatal regions and over the time course of the study. The delivery of infants with MCM at level III centers may be an alternative measure of regionalization.
Mehta
S
S
Division of Health Policy and Clinical Effectiveness, Children's Hospital Medical Center, Cincinnati, OH 45229-3039, USA.
Atherton
H D
HD
Schoettker
P J
PJ
Hornung
R W
RW
Perlstein
P H
PH
Kotagal
U R
UR
D000013:Congenital Abnormalities / Q000453:epidemiology; D003696:Delivery Rooms / Q000145:classification* / Q000706:statistics & numerical data; D005260:Female; D006782:Hospitals, Special / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D016015:Logistic Models; D009820:Ohio / Q000453:epidemiology; D010360:Patient Transfer / Q000706:statistics & numerical data; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology; D012041:Regional Medical Programs / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D013997:Time Factors