News: Delivery volume associated with maternal outcomes at rural hospitals, study says

Whether low-risk or high-risk, obstetric patients at low-volume rural hospitals showed a higher risk for severe maternal morbidity (SMM) in comparison to rural hospitals that delivered a higher volume of babies, according to a study published in JAMA Health Forum. More specifically, hospitals categorized as low volume had a 0.70% SMM rate, while high-volume hospitals had a 0.47% SMM rate, MedPadge Today reported.

Researchers determined a birth volume of 10 to 460 births as low, and greater than 460 as higher volume at rural hospitals. Hospital obstetric volume was determined by the total number of live births and still births equal or greater to 20 weeks of gestation that occurred in one calendar year. They used ICD-10 diagnosis and procedure codes to identify the presence of any of the 20 indicators of SMM, which is defined by the Centers for Disease Control and Prevention as unexpected outcomes of labor and delivery that result in significant short-term or long-term health consequences.

Notably, low-risk patients who gave birth at low-volume rural facilities had more than double the risk of SMM than they did giving birth at high-volume rural hospitals. The study also included an analysis between hospital birth volume category and SMM at urban hospitals, and unlike with rural hospitals, the data showed no statistically significant association.

“These findings imply a need for tailored quality improvement strategies for lower-volume hospitals in rural communities,” the researchers stated in the study.

In an interview with MedPage Today, Stephanie Leonard, PhD, an epidemiologist of Stanford University's Dunlevie Maternal-Fetal Medicine Center, and co-author of the study, said that their research adds to many other studies seeking to understand why the United States has worse SMM rates than other high-resources counties. She also asserted their findings help identify ways that outcomes can be improved.

“This is a group of hospitals that needs support and needs attention, because people in those areas need quality obstetric services too,” Leonard said.

Editor’s note: To read MedPage Today’s coverage of this story, click here. To read the JAMA study, click here.