Assessment of regionalized perinatal programs.

This paper addresses issues encountered in studies of the effectiveness of regionalized perinatal care. Regionalization of perinatal care has been actively promoted based upon the intuition that regionalization should reduce perinatal mortality and morbidity. When assessing the effectiveness of a perinatal service, one is interested in whether the service is being utilized appropriately and, if utilized appropriately, whether it is impacting upon outcome. Studies of utilization of regionalized perinatal care include studies of: utilization of the tertiary centre, non-utilization of the tertiary centre and antenatal transfer patterns. Studies of program impact are few. There is one quasi-experimental study which examines mortality and morbidity impact of a program and a few studies examining indirect hypotheses of the impact of regionalization on mortality. Despite the sparsity of the literature, there is evidence in the papers reviewed that regionalization of care may have impact on both mortality and morbidity. Further studies of the latter are needed. Further studies might also include measures of satisfaction of care providers, satisfaction of patients and maternal attachment, among others. In addition, since preliminary evidence implies that regionalized perinatal care is effective, future studies might include considerations of cost-effectiveness.