[Federal admission criteria for levels of perinatal care: definition, interpretation and first conclusions].
BACKGROUND
The outcome of high risk pregnancies is better in tertiary hospitals. The German government introduced levels of perinatal care only in 2006. The aim of this study was to investigate how many children are to be expected for each level, taking the possible width of interpretation of the admission criteria into account.


METHODS
Perinatal quality assurance data from four German states (2005) were available. Based on the admission criteria used for level definitions, children were categorised into four different levels of care. To illustrate the possible width of interpretation of these admission criteria three analytical strategies were used. In addition, the distribution of children on different types of hospitals prior to the introduction of levels of care was analysed.


RESULTS
Most deliveries (86-93 %) correspond to the lowest level, and only 1-5 % to the highest. Up to 15 % of children who should have been cared for in the highest level were born in hospitals with less than 500 annual deliveries. Among the neonates with risk profiles corresponding to the admission criteria for the two highest levels, up to 30 % were born in delivery units without NICUs. The majority (83 %) of attached NICUs had low caseloads (< 50 neonates < 1500 g / year).


CONCLUSIONS
Most children fulfil the admission criteria for the lowest level of care whereas the need for specialised centres is rather low. Optimising the place of birth appropriately remains a challenge. Definition of levels of care based on admission criteria are difficult to implement due to a broad variety of interpretations.
Eberhard
A
A
Institut für Epidemiologie, Sozialmedizin und Gesundheitssystemforschung, Medizinische Hochschule Hannover.
Wenzlaff
P
P
Lack
N
N
Misselwitz
B
B
Kaiser
A
A
Bartels
D B
DB
D000293:Adolescent; D000328:Adult; D005260:Female; D005858:Germany; D006276:Health Facility Size / Q000706:statistics & numerical data; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006801:Humans; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000453:epidemiology* / Q000628:therapy; D007363:Intensive Care Units, Neonatal / Q000706:statistics & numerical data*; D010343:Patient Admission / Q000706:statistics & numerical data*; D011247:Pregnancy; D018566:Pregnancy, High-Risk; D011295:Prenatal Care; D011785:Quality Assurance, Health Care / Q000706:statistics & numerical data