Hospital factors and nontransfer of small babies: a marker of deregionalized perinatal care?
OBJECTIVE
Our purpose was to examine the contribution of hospital factors (e.g., reimbursement sources, teaching status) to the rate of nontransfer of <1250 g infants born in nontertiary hospitals in Illinois. We chose nontransfer as a marker of the extent to which there have been structural changes in the regionalized perinatal care system in Illinois.


METHODS
Using data from live birth certificates (1989-1996), from the American Hospital Association's Annual Survey of Hospitals (1990 to 1996), and Illinois hospital discharge records (1992 to 1996), we simultaneously assessed the effect of hospital and individual factors on nontransfer of infants <1250 g (n=2904).


RESULTS
When adjusted for individual risk factors, several hospital factors were associated with nontransfer. These include birth in a Level II+hospital (odds ratios(OR) 3.75; 95% CI 2.29, 5.29), high Medicaid revenues (OR 1.97; 95% CI 1.58, 2.47), high HMO revenues (OR 1.39; 95% CI 1.11, 2.28), and status as a teaching hospital (OR 1.63; 95% CI 1.30, 2.09).


CONCLUSIONS
This study suggests that there should be careful consideration of the role of hospital factors in perinatal deregionalization in order to preserve the improvements in maternal and infant outcomes associated with regionalized perinatal care.
Wall
Stephen N
SN
Department of Pediatrics, Chicago Children's Hospital, Pritzker School of Medicine, University of Chicago, Chicago, IL, USA.
Handler
Arden S
AS
Park
Chang Gi
CG
D000328:Adult; D036861:Delivery, Obstetric / Q000379:methods; D004469:Economics, Hospital; D004522:Educational Status; D005006:Ethnicity; D006761:Hospitals / Q000145:classification / Q000706:statistics & numerical data*; D006784:Hospitals, Teaching; D006801:Humans; D007087:Illinois; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight; D007363:Intensive Care Units, Neonatal; D008423:Maternal Age; D008484:Medicaid; D010360:Patient Transfer / Q000706:statistics & numerical data*; D018743:Perinatal Care / Q000458:organization & administration*; D011295:Prenatal Care; D012041:Regional Medical Programs / Q000458:organization & administration*