Regionalization and local hospital closure in Norwegian maternity care--the effect on neonatal and infant mortality.
OBJECTIVE
To study whether neonatal and infant mortality, after adjustments for differences in case mix, were independent of the type of hospital in which the delivery was carried out.


METHODS
The Medical Birth Registry of Norway provided detailed medical information for all births in Norway.


METHODS
Hospitals were classified into two groups: local hospitals/maternity clinics versus central/regional hospitals. Outcomes were neonatal and infant mortality. The data were analyzed using propensity score weighting to make adjustments for differences in case mix between the two groups of hospitals. This analysis was supplemented with analyses of 13 local hospitals that were closed. Using a difference-in-difference approach, the effects that these closures had on neonatal and infant mortality were estimated.


RESULTS
Neonatal and infant mortality were not affected by the type of hospital where the delivery took place.


CONCLUSIONS
A regionalized maternity service does not lead to increased neonatal and infant mortality. This is mainly because high-risk deliveries were identified well in advance of the birth, and referred to a larger hospital with sufficient perinatal resources to deal with these deliveries.
Department of Obstetrics and Gynecology, Institute of Clinical Medicine, Akershus University Hospital, Lørenskog, Norway.
Jostein
J
Grytten
Lars
L
Monkerud
Irene
I
Skau
Rune
R
Sørensen
D006271:Health Facility Closure; D006297:Health Services Accessibility; D006764:Hospitals, Community; D006801:Humans; D007223:Infant; D007226:Infant Mortality / Q000639:trends*; D007231:Infant, Newborn; D016389:Maternal-Child Nursing; D009664:Norway; D057216:Propensity Score; D012040:Regional Health Planning; D012042:Registries
Program evaluation; determinants of health; obstetrics/gynecology; risk adjustment for clinical outcomes