Relationship between hospital policies for labor induction and cesarean delivery and perinatal care quality among rural U.S. Hospitals

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Abstract

Many hospitals are adopting quality improvement strategies in obstetrics. This study characterized rural U.S. hospitals based on their hospital staffing and clinical management policies for labor induction and cesarean delivery, and assessed the relationship between policies and performance on maternity care quality. We surveyed all 306 rural maternity hospitals in nine states and used data from the Healthcare Cost and Utilization Project Statewide Inpatient Database hospital discharge database. We found staffing policies were more prevalent at lower-volume hospitals (92% vs. 86% for cesarean and 82% vs. 79%, both p <.01). Using multivariable logistic regression, we found hospitals with policies for cesarean delivery had up to 24% lower odds of low-risk cesarean (adjusted odds ratio =0.76; 95% confidence interval=[0.67-0.86]) and non-indicated cesarean (0.78 [0.70-0.88]), with variability across birth volume. Clinical management and staffing policies are common, but not universal, among rural U.S. hospitals providing obstetric services and are generally positively associated with quality.

Original languageEnglish (US)
Pages (from-to)128-143
Number of pages16
JournalJournal of health care for the poor and underserved
Volume27
Issue number4
DOIs
StatePublished - Nov 2016

Bibliographical note

Funding Information:
This study was supported by the Federal Office of Rural Health Policy(FORHP), Health Resources and Services Administration(HRSA), U.S. Department of Health and Human Services(HHS) under PHS Grant No. 5U1CRH03717. The information, conclusions and opinions expressed in this manuscript are those of the authors and no endorsement by FORHP, HRSA, or HHS is intended or should be inferred.

Keywords

  • Cesarean delivery
  • Childbirth
  • Hospital policy
  • Labor induction
  • Maternal health
  • Quality of care
  • Rural health

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