Does centralisation of acute obstetric care reduce intrapartum and first-week mortality? An empirical study of over 1 million births in the Netherlands.
In this hypothetical analysis with retrospective cohort data (1,160,708 hospital births) we estimated outcome of centralisation of acute obstetric care, i.e., closure of 10 hospitals (out of 99) in The Netherlands. The main outcome was predicted intrapartum and first-week mortality (further referred to as neonatal mortality) for several subgroups of patients affected by two centralisation scenarios: (1) closure of the 10 smallest hospitals; (2) closure of the 10 smallest hospitals, but avoiding adjacent closures. Predictions followed from regression coefficients from a multilevel logistic regression model. Scenario 1 resulted in doubled travel time, and 10% increased mortality (210 [0.34%] to 231 [0.38%] cases). Scenario 2 showed less effect on mortality (268 [0.33%] to 259 [0.32%] cases) and travel time. Heterogeneity in hospital organisational features caused simultaneous improvement and deterioration of predicted neonatal mortality. Consequences vary for subgroups. We demonstrate that (in The Netherlands) centralisation of acute obstetric care according to the 'closure-of-the-smallest-rule' yields suboptimal outcomes. In order to develop an optimal strategy one would need to consider all positive and negative effects, e.g., organisational heterogeneity of closing and surviving hospitals, differential effects for patient subgroups, increased travel time, and financial aspects. The provided framework may be beneficial for other countries considering centralisation of acute obstetric care.
Department of Obstetrics and Gynaecology, Division of Obstetrics & Prenatal Medicine, Erasmus MC, PO Box 2040, 3000 CA Rotterdam, The Netherlands. Electronic address: v.j.j.poeran@gmail.com.
Jashvant
J
Poeran
Department of Public Health, Erasmus MC, PO Box 2040, 3000 CA Rotterdam, The Netherlands. Electronic address: g.borsboom@erasmusmc.nl.
Gerard J J M
GJ
Borsboom
Department of Obstetrics and Gynaecology, Division of Obstetrics & Prenatal Medicine, Erasmus MC, PO Box 2040, 3000 CA Rotterdam, The Netherlands. Electronic address: j.degraaf@erasmusmc.nl.
Johanna P
JP
de Graaf
Department of Obstetrics and Gynaecology, Division of Obstetrics & Prenatal Medicine, Erasmus MC, PO Box 2040, 3000 CA Rotterdam, The Netherlands; Institute of Health Policy and Management, Erasmus University Rotterdam, PO Box 1738, 3000 DR Rotterdam, The Netherlands. Electronic address: birnie@bmg.eur.nl.
Erwin
E
Birnie
Department of Obstetrics and Gynaecology, Division of Obstetrics & Prenatal Medicine, Erasmus MC, PO Box 2040, 3000 CA Rotterdam, The Netherlands. Electronic address: e.a.p.steegers@erasmusmc.nl.
Eric A P
EA
Steegers
Department of Public Health, Erasmus MC, PO Box 2040, 3000 CA Rotterdam, The Netherlands. Electronic address: j.mackenbach@erasmsusmc.nl.
Johan P
JP
Mackenbach
Department of Obstetrics and Gynaecology, Division of Obstetrics & Prenatal Medicine, Erasmus MC, PO Box 2040, 3000 CA Rotterdam, The Netherlands; Department of Public Health, Erasmus MC, PO Box 2040, 3000 CA Rotterdam, The Netherlands; Rotterdam Midwifery Academy, 'Rochussenstraat building', PO Box 2040, 3000 CA Rotterdam, The Netherlands. Electronic address: g.bonsel@erasmusmc.nl.
Gouke J
GJ
Bonsel
D000328:Adult; D002497:Centralized Hospital Services / Q000458:organization & administration*; D036861:Delivery, Obstetric / Q000379:methods* / Q000706:statistics & numerical data; D005260:Female; D005313:Fetal Death / Q000517:prevention & control; D006291:Health Policy; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D008875:Middle Aged; D009426:Netherlands; D018743:Perinatal Care / Q000458:organization & administration*; D011247:Pregnancy; D011256:Pregnancy Outcome; D012189:Retrospective Studies
Centralized hospital services; Health policy; Neonatal mortality; Netherlands; Obstetrics; Perinatal care