Statement of the problem: Childbirth is the most common reason for hospitalization in the U.S. Approximately one-quarter of all U.S. births occur in rural hospitals, but the number of rural hospitals providing obstetric care has decreased over the past decade. Understanding how obstetric care is currently provided in rural areas and in rural hospitals, including Critical Access Hospitals (CAHs), is important for assessing the quality of maternity services, quantifying implications for maternal and child health, and making policy decisions at the federal, state, local, and hospital levels.

Project goals: The project will examine obstetric care quality and perinatal safety in rural U.S. hospitals nationally, with a focus on rural hospitals in a nationally representative group of eight states. We will improve upon prior research by distinguishing elective obstetric procedures (e.g., labor induction, C-section), paying explicit attention to rural relevance in a broader range of measures, and analyzing quality-related policy implications.

Methods: Using hospital discharge data from Healthcare Cost and Utilization Project national and state databases, we will measure obstetric care quality related to delivery mode, elective procedures, and perinatal safety. We will examine longitudinal trends in these outcomes and characterize outcomes for types of rural hospitals (including CAHs) and for different levels of rurality. We will analyze hospital characteristics associated with particularly high or low quality outcomes, controlling for patient characteristics (e.g., age, type of insurance coverage, pregnancy complications).

Anticipated publications or products: Policy brief, peer-reviewed journal manuscript, and presentations at conferences and to key policy audiences such as the HRSA Maternal and Child Health Bureau, State Medicaid Programs, AHRQ, State Hospital Associations, and State Offices of Rural Health.

Publications

• Obstetric Services and Quality Among Critical Access, Rural, and Urban Hospitals in Nine States
  University of Minnesota Rural Health Research Center
  Date: 06/2013
  This policy brief compares the characteristics and quality of obstetric care in critical access hospitals, other rural hospitals, and their urban counterparts.