Labor and Delivery Unit Closures in Rural Georgia from 2012-2016: A Mixed-Methods Investigation Open Access

Abstract

Obstetric provider coverage in rural Georgia has worsened in the past ten years, with nine rural labor and delivery units closing between 2012 and 2016. Georgia consistently has the highest maternal mortality rate in the nation and faces increased adverse health consequences from this decline in obstetric care. The purpose of this study is to explore what factors may be associated with rural hospital labor and delivery unit (LDU) closures in Georgia between 2012 and 2016. This study describes differences between hospitals in rural Georgia that closed LDUs and those which remained open from 2012 to 2016 through a quantitative analysis of 2011 baseline regional, facility, and patient level data, as well as a qualitative analysis of newspaper articles addressing the closures. Primary factors associated with closure include lower 2011 birth volume among LDUs, lower average annual births per provider, higher proportion of deliveries in PCSA of residence, higher birth volume at nearest hospital, higher proportion of black patients, and higher proportion of Medicaid and self-pay patients. Qualitative results indicate financial distress primary contributed to closures, but also suggest that low birth volume and obstetric provider shortage impacted closures as well. Reports and presentations by the Georgia Maternal and Infant Health Research Group (GMIHRG) were found to stimulate news article publication regarding LDU closure, indicating the effectiveness of research and advocacy on LDU closure publicity. In effort to prevent further LDU closure and poor maternal health outcomes, this study recommends increasing attention to hospital LDU risk factors, advocating for communities vulnerable to closure, and developing creative healthcare delivery methods post-closure.

Table of Contents

Glossary…………………………………………………………………………………...…...1

Introduction………………………………………………………………………………….....2

Ch 1. Literature Review……………………………………………………………………......4

Ch 2. Methods……………………………………………………………………………...…12

Ch 3. Results: Regional Assessment ……….…………………………………………...........22

   Figure 1a. Map of Georgia hospitals which delivered babies in 2011…....………...........…22

Ch 4. Results: Facility Assessment….……………………………………………………......28           

  Table 3. Facility- and patient- level factors by LDU closure status (2011)………………....29

Ch 5. Results: LDU in the News Assessment……………………………………………...…44

   Figure 23. Conceptual Framework: “Contributors to Rural LDU Closure in Georgia”........56

Ch 6. Discussion…………………………………………………………………………...…58

Ch 7. Implications………………………………………………………………………...…..62

References……………………………………………………………………………...……..64

About this Master's Thesis

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School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
Keyword	Rural Georgia Obstetric Care Maternal and Child Health Labor and Delivery Unit Closure
Committee Chair / Thesis Advisor	Rochat, Roger, Emory University
Partnering Agencies	Georgia state or local health department

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