333214
A model for evaluating statewide perinatal regionalization to improve outcomes for high-risk mothers and infants
Background: Risk appropriate care for mothers and infants is critical to improving perinatal outcomes. The AHA Survey of Hospitals shows a 9.2% increase in births between 1987 and 2010 and a 96.5% increase in neonatal special care beds. Doubling of special care beds in this 21-year period has “created demand” for subspecialty services and has “de-regionalized” well- functioning systems.
Method: Regionalization within a state can be analyzed and monitored using the existing discharge abstract dataset that is economical to use, has data on all births and offers MCH leadership a tool to actively reinforce and support the alignment of risk appropriate, high quality care. Discharge data is used to assess where high-risk mothers are delivered, the location of birth for low/ very low birth weight newborns, the proportion born outside the regional perinatal centers and whether transfers occur in a timely manner. Analysis by payer group, especially for the Medicaid population, can show whether this population is getting appropriate access and the liability to the state where it is not.
Results: Using the statewide discharge data set, MCH leaders can identify where regionalization is strongest and weakest so planning efforts can be maximized.
Conclusions
An ever increasing proportion of perinatal care is being paid for by state governments through the Medicaid system. Inefficient systems of risk-appropriate care have immediate short term and often serious long term costs. Each state has a fiduciary responsibility to its citizens to insure that high quality care is matched with the greatest need.
Learning Areas:
Administration, management, leadershipProgram planning
Public health or related laws, regulations, standards, or guidelines
Public health or related public policy
Systems thinking models (conceptual and theoretical models), applications related to public health
Learning Objectives:
Describe the manpower and reimbursement forces that have undermined perinatal regionalization
Define the components of the discharge abstract data set that can be used to model the degree of regionalization within a region and statewide
Identify process and outcome metrics that can used to assess and monitor the degree of risk appropriate care for the MCH population
Keyword(s): Birth Outcomes, Health Care Delivery
Qualified on the content I am responsible for because: The National Perinatal Information Center, has worked with administrative data for close to 30 years. We developed the model to use these statewide data sets to analyze the risk profile of the mother/inborn with the level of care of the birth facility. We used the model in MCH subcontracts with PA and VA and in smaller system level applications. The national focus on "re-regionalizing" perinatal care makes the model a timely tool.
Any relevant financial relationships? No
I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.