Variation in childbirth services in California: a cross-sectional survey of childbirth hospitals.
OBJECTIVE
The objective of the study was to describe the resources and activities associated with childbirth services.


METHODS
We adapted models for assessing the quality of healthcare to generate a conceptual framework hypothesizing that childbirth hospital resources and activities contributed to maternal and neonatal outcomes. We used this framework to guide development of a survey, which we administered by telephone to hospital labor and delivery nurse managers in California. We describe the findings by hospital type (ie, integrated delivery system [IDS], teaching, and other [community] hospitals).


RESULTS
Of 248 nonmilitary childbirth hospitals in California, 239 (96%)responded; 187 community, 27 teaching, and 25 IDS hospitals reported. The context of services varied across hospital types, with community hospitals more likely to have for-profit ownership, be in a rural or isolated location, and have fewer annual deliveries per hospital. Results included the findings of the following: (1) 24 hour anesthesia availability in 50% of community vs 100% of IDS and teaching hospitals (P < .001); (2) 24 hour in-house labor and delivery physician coverage in 5% of community vs 100% of IDS and 48% of teaching hospitals (P < .001); (3) 24 hour blood bank availability in 88% of community vs 96% of IDS and 100% of teaching hospitals (P = .092); (4) adult subspecialty intensive care unit availability in 33% of community vs 36% of IDS and 82% of teaching hospitals (P < .001); (5) ability to perform emergency cesarean delivery in 30 minutes 100% of the time in 56% of community vs 100% of IDS and 85% of teaching hospitals (P < .001); (6) pediatric care available both day and night in 54% of community vs 63% of IDS vs 76% of teaching hospitals (P = .087); and (7) no neonatal intensive care unit in 44% of community vs 12% of IDS and 4% of teaching hospitals (P < .001).


CONCLUSIONS
Childbirth services varied widely across California hospitals. Cognizance of this variation and linkage of these data to childbirth outcomes should assist in the identification of key resources and activities that optimize the hospital environment for pregnant women and set the groundwork for identifying criteria for the provision of maternal risk-appropriate care.
Childbirth Research Associates, North Hollywood, CA.
Lisa M
LM
Korst
Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Burns and Allen Research Institute, Los Angeles, CA.
Daniele S
DS
Feldman
Community Perinatal Network, Yorba Linda, CA.
D Lisa
DL
Bollman
AMF Consulting, Los Angeles, CA.
Moshe
M
Fridman
Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Burns and Allen Research Institute, Los Angeles, CA.
Samia
S
El Haj Ibrahim
Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA; Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, CA; Langley Research Institute, Pacific Palisades, CA.
Arlene
A
Fink
Department of Family Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA.
Lacey
L
Wyatt
Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Burns and Allen Research Institute, Los Angeles, CA; Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California, Los Angeles, CA; Department of Community Health Sciences, Fielding School of Public Health, University of California, Los Angeles, CA. Electronic address: gregory@cshs.org.
Kimberly D
KD
Gregory
D000773:Anesthesia, Obstetrical / Q000706:statistics & numerical data; D001771:Blood Banks / Q000706:statistics & numerical data; D002140:California; D002585:Cesarean Section / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D036861:Delivery, Obstetric / Q000706:statistics & numerical data; D005260:Female; D006297:Health Services Accessibility; D006301:Health Services Needs and Demand; D006761:Hospitals; D006764:Hospitals, Community / Q000706:statistics & numerical data*; D006784:Hospitals, Teaching / Q000706:statistics & numerical data*; D006801:Humans; D007231:Infant, Newborn; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007363:Intensive Care Units, Neonatal / Q000706:statistics & numerical data; D008427:Maternal Health Services; D008505:Medical Staff, 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; D011795:Surveys and Questionnaires
childbirth hospital services; childbirth hospital types; hospital staffing; risk-appropriate care; supply-side barriers