Influence of perinatal care regionalisation on the referral patterns of intermediate- and high-risk pregnancies.
OBJECTIVE
To use the delivery site according to the birth weight as a marker of changes in the referral practices after regionalisation of perinatal care.


METHODS
Analysis of the distribution of low birth weight infants according to the level of care in Rhone-Alpes from 1998 to 2000 and analysis of the birth rate heterogeneity according to the delivery site characteristics.


RESULTS
The distribution of infants<or=1500 g remained constant at all levels (60% at level 3). That of infants 1500-2000 g born at level 3 dropped in 2000 but raised at levels 1 and 2. For both weight categories, the lower birth rates corresponded to the private, the lower-flow, and the more distant from neonatal intensive care units facilities. For infants<or=1500 g, the level 3 birth rate was four times the level 2 (P=0.0006) and five times the level 1 (P<0.0001) rates. For infants 1500-2000 g, level 3 birth rate was twice the level 2 (P=0.0096) and 3.6 times the level 1 (P<0.0001) rates. Birth rates were always significantly higher in university than in private facilities.


CONCLUSIONS
Supervising level 3 is insufficient to show the effect of regionalisation. A more accurate analysis of intermediate-risk referral determinants is needed to reach a more demand/supply adequacy.
Pasquier
Jean-Charles
JC
Department of Obstetrics, Edouard Herriot Hospital (Hospices Civils de Lyon) and Claude Bernard University, Lyon, France. jean-charles.pasquier@chu-lyon.fr
Rabilloud
Muriel
M
Janody
Géraldine
G
Abbas-Chorfa
Fatima
F
Ecochard
René
R
Mellier
Georges
G
D001723:Birth Rate; D001724:Birth Weight; D005260:Female; D005602:France; D006801:Humans; D015931:Intensive Care, Neonatal / Q000706:statistics & numerical data; D018743:Perinatal Care / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians'; D011247:Pregnancy; D018566:Pregnancy, High-Risk; D012017:Referral and Consultation / Q000706:statistics & numerical data*