title: Cross-sectional survey of California childbirth hospitals: implications for defining maternal levels of risk-appropriate care.
abstract: OBJECTIVE
  Measures of maternal mortality and severe maternal morbidity have risen in the United States, sparking national interest regarding hospitals' ability to provide maternal risk-appropriate care. We examined the extent to which hospitals could be classified by increasingly sophisticated maternal levels of care.
  
  
  METHODS
  We performed a cross-sectional survey to identify hospital-specific resources and classify hospitals by criteria for basic, intermediate, and regional maternal levels of care in all nonmilitary childbirth hospitals in California. We measured hospital compliance with maternal level of care criteria that were produced via consensus based on professional standards at 2 regional summits funded by the March of Dimes through a cooperative agreement with the Community Perinatal Network in 2007 (California Perinatal Summit on Risk-Appropriate Care).
  
  
  RESULTS
  The response rate was 96% (239 of 248 hospitals). Only 82 hospitals (34%) were classifiable under these criteria (35 basic, 42 intermediate, and 5 regional) because most (157 [66%]) did not meet the required set of basic criteria. The unmet criteria preventing assignment into the basic category included the ability to perform a cesarean delivery within 30 minutes 100% of the time (only 64% met), pediatrician availability day and night (only 56% met), and radiology department ultrasound capability within 12 hours (only 83% met). Only 29 of classified hospitals (35%) had a nursery or neonatal intensive care unit level that matched the maternal level of care, and for most remaining hospitals (52 of 53), the neonatal intensive care unit level was higher than the maternal care level.
  
  
  CONCLUSIONS
  Childbirth services varied widely across California hospitals, and most hospitals did not fit easily into proposed levels. Cognizance of this existing variation is critical to determining the optimal configuration of services for basic, intermediate, and regional maternal levels of care.
authors.affiliation: Childbirth Research Associates, North Hollywood, CA.
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Korst
authors.affiliation: Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Burns Allen Research Institute, Los Angeles, CA.
authors.forename: Daniele S
authors.initials: DS
authors.lastname: Feldman
authors.affiliation: Community Perinatal Network, Yorba Linda, CA.
authors.forename: D Lisa
authors.initials: DL
authors.lastname: Bollman
authors.affiliation: AMF Consulting, Los Angeles, CA.
authors.forename: Moshe
authors.initials: M
authors.lastname: Fridman
authors.affiliation: Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Burns Allen Research Institute, Los Angeles, CA.
authors.forename: Samia
authors.initials: S
authors.lastname: El Haj Ibrahim
authors.affiliation: Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA; Department of Health Policy and Management, Fielding School of Public Health at UCLA, Los Angeles, CA; Langley Research Institute, Pacific Palisades, CA.
authors.forename: Arlene
authors.initials: A
authors.lastname: Fink
authors.affiliation: Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Burns Allen Research Institute, Los Angeles, CA; Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Los Angeles, CA; Department of Community Health Sciences, Fielding School of Public Health at UCLA, Los Angeles, CA. Electronic address: gregory@cshs.org.
authors.forename: Kimberly D
authors.initials: KD
authors.lastname: Gregory
mesh_terms: D000773:Anesthesia, Obstetrical / Q000706:statistics & numerical data; D002140:California; D002585:Cesarean Section / Q000592:standards*; D003430:Cross-Sectional Studies; D005260:Female; D006297:Health Services Accessibility / Q000592:standards*; D006761:Hospitals / Q000592:standards*; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal / Q000706:statistics & numerical data; D008427:Maternal Health Services / Q000592:standards*; D008505:Medical Staff, Hospital / Q000706:statistics & numerical data; D009725:Nurseries, Hospital / Q000706:statistics & numerical data; D009741:Nursing Staff, Hospital / Q000706:statistics & numerical data; D009774:Obstetrics / Q000706:statistics & numerical data; D036801:Parturition; D010372:Pediatrics / Q000706:statistics & numerical data; D011247:Pregnancy; D011787:Quality of Health Care; D011795:Surveys and Questionnaires; D013997:Time Factors; D014463:Ultrasonography / Q000706:statistics & numerical data
keywords: childbirth hospital services; hospital staffing; maternal health; maternal levels of care; risk-appropriate care