Evaluating the Impact of Obstetrical Unit Closures on Severe Maternal Morbidity in Pennsylvania

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Publication Date

4-29-2024

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Presentation: 1:06:26

Abstract

Background
Severe Maternal Morbidity (SMM) is defined as the 21 diagnoses and procedures that are “unexpected outcomes of labor and delivery that result in significant short- or long-term consequences to a woman’s health.” SMM rates have been shown to be higher for women with specific risk factors, but no study has examined this for Pennsylvanian women. Obstetrical units across the United States are closing due to hospital mergers, workforce reductions, and low reimbursement rates. Closures have been shown to increase the likelihood of adverse maternal health outcomes, but few studies have linked these events to SMM.

Objective
This study had two objectives: to understand the individual factors that increase the likelihood of a woman experiencing SMM and to understand if there is a connection between obstetrical unit closures and SMM.

Methods
This study used Pennsylvania inpatient delivery data and records of open obstetrical units from 2016 to 2021. Five multilevel models were created; each had SMM as the primary outcome variable and nested deliveries by the county where it occurred. The first inputted individual factors into the model to analyze which were predictors of SMM. The following four looked at the impact of obstetrical unit closures using variables that tabulated the total number open, whether there was a closure the year prior to or the year of the delivery, and the total number of closures across the five years.

Results
Across 2016-2021, 13 obstetrical units closed in Pennsylvania. Despite deliveries declining, SMM increased from occurring in 5% of deliveries in 2016 to 7% in 2021. Black women experienced SMM at a much higher rate than their White counterparts (10% versus 5%); they also had 70% greater odds of experiencing SMM than White women. An obstetrical unit closing the year prior to delivery resulted in a greater risk of SMM than a closure the same year. The total number of closures across the five year time period increased the risk of SMM by 33%.

Conclusions
There needs to be continued research into the burden and risk factors for SMM at both the state and national levels. Policies could be explored to help keep obstetrical units open, including mitigating the impact of mergers and acquisitions and strengthening the maternal health workforce.

Language

English

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