title: Fragmentation of Care in Ectopic Pregnancy.
abstract: OBJECTIVE
  Ectopic pregnancy is an important cause of maternal morbidity and mortality. Women who experience fragmented care may undergo unnecessary delays to diagnosis and treatment. Based on ectopic pregnancy cases observed in clinical practice that raised our concern about fragmentation of care, we designed an exploratory study to describe the number, characteristics, and outcomes of fragmented care among patients with ectopic pregnancy at one urban academic hospital.
  
  
  METHODS
  Chart review with descriptive statistics. Fragmented care was defined as a patient being evaluated at an outside facility for possible ectopic pregnancy and transferred, referred, or discharged before receiving care at the study institution.
  
  
  RESULTS
  Of 191 women seen for possible or definite ectopic pregnancy during the study period, 42 (22 %) met the study definition of fragmented care. The study was under-powered to observe statistically significant differences across groups, but we found concerning, non-significant trends: patients with fragmented care were more likely to be Medicaid recipients (65.9 vs. 58.8 %) and to experience a complication (23.8 vs. 18.1 %) compared to those with non-fragmented care. Most patients (n = 37) received no identifiable treatment prior to transfer and arrived to the study hospital with no communication to the receiving hospital from the outside provider (n = 34). Nine patients (21 %) presented with ruptured ectopic pregnancies. The fragmentation we observed in our study may contribute to previously identified socio-economic disparities in ectopic pregnancy outcomes.
  
  
  CONCLUSIONS
  If future research confirms these findings, health information exchanges and regional coordination of care may be important strategies for reducing maternal mortality.
authors.affiliation: Department of Family Medicine, The University of Chicago, 5841 South Maryland Avenue MC 7110, Suite M - 156, Chicago, IL, 60637, USA. stulberg@uchicago.edu.|Departments of Obstetrics and Gynecology, The University of Chicago, 5841 S. Maryland Ave., MC2050, Chicago, IL, 60637, USA. stulberg@uchicago.edu.|Maclean Center for Clinical Medical Ethics, The University of Chicago, Chicago, IL, USA. stulberg@uchicago.edu.
authors.forename: Debra B
authors.initials: DB
authors.lastname: Stulberg
authors.affiliation: Department of Family Medicine, The University of Chicago, 5841 South Maryland Avenue MC 7110, Suite M - 156, Chicago, IL, 60637, USA.
authors.forename: Irma
authors.initials: I
authors.lastname: Dahlquist
authors.affiliation: Psychiatry Residency Program, University of Minnesota, F282/2A West, 2450 Riverside Avenue South, Minneapolis, MN, 55454, USA.
authors.forename: Christina
authors.initials: C
authors.lastname: Jarosch
authors.affiliation: Departments of Obstetrics and Gynecology, The University of Chicago, 5841 S. Maryland Ave., MC2050, Chicago, IL, 60637, USA.|Maclean Center for Clinical Medical Ethics, The University of Chicago, Chicago, IL, USA.|Department of Medicine - Geriatrics, The University of Chicago, Chicago, IL, USA.
authors.forename: Stacy T
authors.initials: ST
authors.lastname: Lindau
mesh_terms: D000328:Adult; D003266:Continuity of Patient Care; D005006:Ethnicity; D005260:Female; D019538:Health Care Surveys; D006297:Health Services Accessibility; D054625:Healthcare Disparities; D006801:Humans; D008428:Maternal Mortality; D008484:Medicaid; D011203:Poverty; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology; D011256:Pregnancy Outcome; D011271:Pregnancy, Ectopic / Q000175:diagnosis / Q000208:ethnology / Q000628:therapy; D014481:United States
keywords: Ectopic pregnancy; Fragmentation of care; Maternal morbidity; Processes of care