title: Local health department perspectives on linkages among birthing hospitals.
abstract: OBJECTIVE
  To describe perinatal linkages among hospitals, changes in their numbers and their impact on relationships among high-risk providers in local communities.
  
  
  METHODS
  Data were obtained about the organization of perinatal services in 1996-1999 from a cross-sectional study evaluating fetal and infant mortality review (FIMR) programs nationwide. Geographic areas were sampled based on region, population density, and the presence of a FIMR. A local health department representative was interviewed in 76% (N=193) of eligible communities; 188 provided data about hospitals.
  
  
  RESULTS
  Linkages among all hospitals were reported in 143 communities and with a subspecialty hospital in 122. All but 12 communities had a maternity hospital, and changes in the number of hospitals occurred in 49 communities. Decreases in the number of Level II hospitals were related to changes in relationships among providers of high-risk care for mothers and newborns; they were associated with changing relationships only for mothers in Level I hospitals. These relations were noted only where established provider relationships existed.
  
  
  CONCLUSIONS
  Decreases in the number of maternity hospitals affect provider relationships in communities, but only where there are established linkages among hospitals.
authors.affiliation: Women's and Children's Health Policy Center, Department of Population and Family Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
authors.forename: Donna M
authors.initials: DM
authors.lastname: Strobino
authors.forename: Gillian Beth
authors.initials: GB
authors.lastname: Silver
authors.forename: Adam A
authors.initials: AA
authors.lastname: Allston
authors.forename: Holly A
authors.initials: HA
authors.lastname: Grason
mesh_terms: D003422:Critical Care; D005260:Female; D006771:Hospitals, Maternity / Q000458:organization & administration* / Q000706:statistics & numerical data; D006801:Humans; D007231:Infant, Newborn; D007373:Interinstitutional Relations; D009935:Organizational Affiliation; D010360:Patient Transfer / Q000458:organization & administration; D018743:Perinatal Care / Q000458:organization & administration*; D011247:Pregnancy; D018566:Pregnancy, High-Risk; D011635:Public Health Administration; D012017:Referral and Consultation / Q000458:organization & administration; D014164:Transfer Agreement / Q000706:statistics & numerical data; D014481:United States