Taylor J, Zweig S, Williamson H, Lawhorne L, Wright H
J Rural Health. 1989 Oct;5(4):343-52. doi: 10.1111/j.1748-0361.1989.tb00995.x.
As family and general practitioners who provide a substantial portion of the obstetric care in rural areas quit their obstetric practice, small rural hospital obstetric units are at risk of closing. Using a case study design, we examined the impact of the loss of obstetric services at a small rural hospital in Missouri. This unit was the site of delivery for less than one-half of the infants born to women living within its service area. However, it was the most likely source of care for women who were young, undereducated and unmarried (p less than 0.01). Evidence derived from birth certificates showed that women who delivered there had good perinatal outcomes compared with local women who delivered at larger hospitals. A gradual decline in the number of physicians providing obstetric care preceded the closing of the hospital unit. Women from the hospital service area who presented late for prenatal care were twice as likely to have had a low birthweight infant in the year after the local hospital unit closed (16.7% versus 7.4%), although this difference and other comparisons of outcomes were not statistically significant.
由于在农村地区提供大部分产科护理服务的家庭医生和全科医生放弃了产科业务，农村小型医院的产科科室面临关闭风险。我们采用案例研究设计，考察了密苏里州一家农村小型医院产科服务缺失所产生的影响。该科室在其服务区域内为不到半数的产妇接生。不过，对于年轻、受教育程度低且未婚的女性而言，这里是最有可能的医疗服务来源（p值小于0.01）。出生证明提供的证据表明，在该科室分娩的女性与在大型医院分娩的当地女性相比，围产期结局良好。在医院科室关闭之前，提供产科护理服务的医生数量逐渐减少。当地医院科室关闭后的一年里，来自该医院服务区域且产前护理延迟的女性生出低体重婴儿的可能性是其他女性的两倍（16.7% 对7.4%），尽管这一差异以及其他结局比较在统计学上并不显著。
