Hamadi Hanadi Y, Xu Jing, Tafili Aurora A, Smith Farouk S, Spaulding Aaron C
Health Administration Program, Department of Health Administration, University of North Florida, 1 UNF Drive, Building 39 Room 4033, Jacksonville, FL, 32224, USA.
Department of Health Services Administration, University of Alabama at Birmingham, 1720 University Blvd, Birmingham, AL, 35294, USA.
Matern Child Health J. 2022 Feb;26(2):358-366. doi: 10.1007/s10995-021-03240-1. Epub 2021 Oct 6.
Birth trauma rates in term of neonates is a quality measure used by the Joint Commission. In the United States birth trauma rates occurs at a rate of 37 per 1000 live births and are on the decline. However, this decline has been significantly lower among term neonates born in rural facilities. There is a critical lack of evidence toward the influence geographical risk factors has on birth trauma rates for neonatal patients. We sought to measure rural community and hospital characteristics associated with birth trauma.
A retrospective longitudinal study design was used to examine inpatient medical discharge data across 103 hospitals of neonates at birth from 2013 to 2018. Discharge data was linked to the American Hospital Association annual survey. We used a multi-level mixed effect model to investigate the relationship between individual and hospital-level attributes associated with increased risk of birth trauma among neonatal patients.
We found that rural hospitals were 3.99 times (p < 0.001) more likely to experience higher birth trauma than urban hospitals. Medium sized hospitals were 2.11 times (p < 0.001) more likely to experience higher birth trauma. Hospitals who indicate having a safety culture were more likely (p < 0.05) to have high rates of birth trauma.
Neonates born at rural hospitals, were more likely to experience a birth-related injury. Policy strategies focusing on improving health care quality in rural areas are critical to mitigating this increased risk of birth trauma. Further research is required to assess how physician characteristics may impact birth trauma rates.
新生儿出生创伤率是联合委员会使用的一项质量指标。在美国，出生创伤率为每1000例活产中有37例，且呈下降趋势。然而，在农村医疗机构出生的足月儿中，这种下降幅度明显较小。关于地理风险因素对新生儿患者出生创伤率的影响，目前严重缺乏证据。我们试图衡量与出生创伤相关的农村社区和医院特征。
采用回顾性纵向研究设计，对2013年至2018年期间103家医院出生的新生儿住院医疗出院数据进行检查。出院数据与美国医院协会年度调查相关联。我们使用多层次混合效应模型来研究个体和医院层面属性与新生儿患者出生创伤风险增加之间的关系。
我们发现，农村医院发生较高出生创伤的可能性是城市医院的3.99倍（p < 0.001）。中型医院发生较高出生创伤的可能性是2.11倍（p < 0.001）。表明拥有安全文化的医院更有可能（p < 0.05）出现较高的出生创伤率。
在农村医院出生的新生儿更有可能经历与出生相关的伤害。关注改善农村地区医疗保健质量的政策策略对于减轻这种出生创伤风险的增加至关重要。需要进一步研究来评估医生特征如何可能影响出生创伤率。
