The Pennsylvania Department of Health (PDOH) contracted with NPIC/QAS to conduct a baseline study of Perinatal Care in Pennsylvania. The study had three analytic objectives to identify the process of care, its impact on outcomes and the overall efficiency of the care delivered. To accomplish these objectives, NPIC/QAS surveyed all Pennsylvania hospitals with obstetrical and/or neonatal services. The survey was linked to hospital discharge data for the same time period as the survey.
The study then examined the risk and geographic residence of mothers and infants and the correspondence of level of risk and the appropriateness of the care provided. The analysis matched the patient level of risk with the level of care provided at the delivery hospital in six community health districts.
The study conclusion identified a fairly high risk degree of regionalization of perinatal care across the hospitals. NPIC/QAS identified that Northwest and North Central Region (rural) had a high number of high risk deliveries in basic level hospitals. This was especially true in rural areas of the state.
The state needed to place greater emphasis on high risk maternal transport to appropriate level III perinatal centers. Finally, there was a need to rationalize the system for delivery of high risk perinatal care.
Perinatal High Risk Analysis
This project was designed to develop service criteria and practice guidelines for high risk obstetrical and neonatal patients in Florida statewide. The reports included an assessment of how all the perinatal centers in the state conformed to state guidelines on size, volume staffing, coverage and services for high risk mothers and infants. The study also examined outcomes of infants and the corresponding level of care of the hospital caring for these infants.
The study conclusion identified discrepancies in level II hospitals behaving as level III hospitals in the case of high risk infants. Although 75% of infants below 1,000 grams were born in level II hospitals, of the remaining 25% born in level II hospitals, a significant proportion (30%) were not "up-transferred". Mortality rates across all hospitals appeared acceptable despite infringement by some hospitals on the perinatal guidelines.
Finally, the study included development of an equitable reimbursement formula for bundled payment to hospitals and physicians for the care of high-risk women and sick/low birthweight neonates.
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