Perinatal Regionalization in Georgia: How are we Performing? 公开
Barrera, Chloe M. (2015)
Abstract
Background : Beginning in the 1970's, hospitals in Georgia began applying for perinatal level designation to support a regionalized system of perinatal care. Since their original designation, they have never been required to reaffirm their level. As a result, these designations no longer reflect the guidelines of the Perinatal Standards of Care by the American Academy of Pediatrics (AAP) and the American Congress of Obstetrics and Gynecology (ACOG). This has serious implications for service provision as well as infant mortality and morbidity.
Purpose: This study examines the current state of the regionalization of perinatal care in Georgia by examining which hospitals fail to meet their current level designation based on the current standards of perinatal levels of care. Additionally the study examines the percent of very low birth weight (VLBW <1500g) infants who are being born in the appropriate level of care (Level III or higher) and observes the patterns of maternal and neonatal transfers.
Methods: The Georgia Department of Public Health (DPH), along with a team of Emory students, developed a cross-sectional survey aimed at elucidating hospitals' level of care based on a series of indicators relating to each level. This survey was administered to all perinatal care hospitals in the state of Georgia (N=84 at the time of survey distribution). Data analysis was conducted using IBM's SPSS, version 19.0 and included descriptive statistics. An algorithm was applied to each survey to assign each hospital a level of care consistent with the AAP/ACOG Guidelines.
Results: The study sample included 57 (68%) hospitals. The survey revealed that 30 (52%) of the hospitals that completed the survey are practicing one level below their DPH designation. Additionally, it was found that only 15.8% of VLBW infants are being born in the appropriate level of care.
Conclusion: This study revealed that the majority of reporting hospitals in Georgia are not practicing at their designated level of perinatal care. In order to improve infant health outcomes across the state, hospitals need to be redesignated and a system of regionalization be fully implemented.
Table of Contents
LIST OF TABLES. 1
LIST OF FIGURES. 2
LIST OF APPENDICES. 3
CHAPTER 1: INTRODUCTION. 4
Problem Definition. 4
Project Description. 5
Formal Statement of Problem. 6
CHAPTER II: BACKGROUND AND LITERATURE REVIEW. 7
Origin of the Regionalization of Perinatal Care. 7
Perinatal Regionalization Guidelines Today. 8
Benefits of Regionalization. 10
"Deregionalization" Explained through Theoretical Framework. 12
Barriers to Successful Regionalization. 16
Consequences of a Lack of Regionalization. 18
Georgia's Infant Health Outcomes. 19
Regionalization in Georgia. 20
Research Aim and Hypothesis. 21
CHAPTER III: METHODS. 22
Stakeholder Identification. 22
Pilot Test. 23
Final Data Collection Instrument. 25
Survey Algorithm Development. 25
Survey Distribution. 27
Study Sample. 27
Statistical Analysis. 27
CHAPTER IV: RESULTS. 30
Perinatal Level Designations. 30
VLBW Deliveries. 31
Antenatal and Neonatal Transfers. 31
CHAPTER V: DISCUSSION. 33
Interpretation and Implications. 33
Hospital's Self-Assessment of Level Designation. 34
Limitations. 35
Recommendations for the Georgia Department of Public Health. 36
Reversing "Deregionalization". 38
Concluding Remarks. 40
REFERENCES. 41
TABLES. 47
FIGURES. 56
APPENDICES. 60
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