Residential Proximity and Hospital Level of Service - A Geospatial Epidemiological Study of Obstetrical Outcomes

Lead Researcher and Department
Dr. Kris Aubrey, Department of Family Medicine, Faculty of Medicine, Memorial University

Collaborators and Students
Dr. Peter Wang, Epidemiology, Faculty of Medicine; Dr. Alvin Simms, Geography Department; Dr. Joan Crane, Obstetrics & Gynecology, Faculty of Medicine; Dr. Marshall Crane, Family Medicine, Faculty of Medicine; Ms. Andrea Pike, Family Medicine, Department of Medicine, Memorial University

Funding Resources
Application to CIHR pending
Application to Cox grant pending

Summary
Women from rural areas where obstetrical deliveries are not performed often face long travel times to reach a hospital that does offer these services. Where obstetrical programs do exist in rural areas, local volumes usually don’t allow a full range of services such as those that are offered in large urban centres. Despite the limited services available in rural areas, previous research suggests that neonatal mortality, hospital charges, and the risk of an abnormal neonate are all greater for women with poor access to care at their home hospital, even though those women are usually travelling to deliver at high volume, specialized centres. Thus, in determining the obstetrical outcomes for rural women, it appears as though proximity to care is more important than the level of service offered. Despite this, obstetrical programs in small rural hospitals are closing. We estimate that 25,000 Canadian women per year must travel away from their home communities to deliver their babies, often at great inconvenience and expense.

We will study the outcomes for women and their babies from all regions of the country, ranging from those with no services to the most highly specialized centres. We are primarily interested in comparing the outcomes for women from areas with no services to those from similar areas with higher levels of service. From this information, we hope to help clarify the optimal level of services required at rural hospitals. We will analyze previously gathered hospital data for all births across the country over a two year period. Women will be grouped according to the level of obstetrical services available at their local hospital. The rate of maternal death and all major adverse maternal outcomes (e.g. infection, surgery, heart attack), as well as the rate of perinatal mortality (death of infants before 8 days) will be compared between groups.

Given previous evidence and our own clinical experience, we hypothesize that:
1. The best obstetrical outcomes will be found for women delivering at large volume, specialized obstetrical centers.
2. Obstetrical outcomes for women from isolated smaller communities will be best where services are offered locally.
3. The capability to perform caesarean deliveries will further increase the level of safety of programs in smaller communities.
4. For women delivering at lower level centres, proximity to a higher level centre will enhance the level of safety.

The information collected from this study will allow women, particularly from rural areas, to be better informed when choosing the delivery location most suited to their needs. For example, we will provide information on the level of risk (if any) to a woman that chooses the convenience of delivering at a local hospital with a lower level of services rather than travel to a more highly specialized hospital. This information will also help policy makers to determine the most appropriate level of care to offer at rural hospitals.

Keywords
Obstetrics, Obstetrical outcomes, Neonatal outcomes, Perinatal mortality, Hospital service level, Canada, Health services research, Rural hospitals

Locations
Canada
St. John's
Avalon Peninsula

Industry Sectors
General Medical and Surgical Hospitals (Health Care and Social Assistance — Hospitals)

Thematic Categories
Hospitals (Health)
Patients (Health)

Departments
Geography, Faculty of Arts (STJ)
Clinical Disciplines, Faculty of Medicine (STJ)
Community Health and Humanities, Faculty of Medicine (STJ)