Examining the Impact of Non-Resident Births on Systems Limitations in Philadelphia
Obstetrical Care
Cynthia L. Line, Ph.D.Patricia Morris, MPH
Katherine C. Maus, ACSW, LSWPhiladelphia Department of Public Health,
Division of Maternal, Child and Family Health
Background
Year
# of Labor & Delivery Hospitals
# of Resident Births
1997 19 22,038
2007 8 23,476
2008 (September) 7
15,069
(through 9/4/08)
Philadelphia Births, 2003-2007*
22087
21631
22027
22905
23476
21000
22000
23000
24000
2003 2004 2005 2006 2007
Year
Nu
mb
er
of
Bir
ths
99.2
* 2007 Birth data are preliminary
BackgroundBy 2007 multiple processes were underway
- each representing a different part of the obstetrical picture
Gathering qualitative data from consumers
Local healthcare system advocacy
Public health system study
•Women’s access to delivery options might be limited
•Systems planning should occur to mitigate other worries
•Hospitals are operating at/near capacity
Background
There were various conclusions, including:
Gathering qualitative data from consumers
Public Health system study
Local healthcare system advocacy
Background
Limitations of simultaneous multiple processes
– Limited communication– Limited data sharing/analysis– Limited solutions
Background
• The Division of Maternal, Child and Family Health (Philadelphia Health Department) proposed a different process:Upon completion of simultaneous multiple processes, unite under a common purpose to better understand OB capacity and subsequent impacts in Philadelphia
Improving Practice
Mid- 2007 the Philadelphia Department of Public Health convened and hosted a meeting of key stakeholders and decision makers:
Hospital CEO’s
OB Department Chairs
Representatives from the Philadelphia Health Centers
(FQHC and city)
Midwifery community
Health insurers
MCH advocates in the city
Improving PracticePhiladelphia Health Department would share
information from its analysis for systems planning, including the following findings:– Despite hospital closures, there do not appear to be significant
changes in birth outcomes for Philadelphia residents• Including changes in the geographic distribution of existing
hospitals
– System changes have disproportionately impacted certain hospitals
– Total available delivery beds in Philadelphia and nearby suburbs might become inadequate for the number of Philadelphia and suburban births
Improving Practice
Three taskforces were convened and charged with work into 2008:
1. Sentinel Perinatal Health Events2. OB Services for Uninsured and
Undocumented Pregnant Women3. OB Services Reimbursement Taskforce
Each taskforce was co-chaired by a stakeholder and a Health Department staff member
Improving PracticeSome Conclusions:
1. Sentinel Perinatal Health EventsCollect sentinel events metricsImplement data sharing
2. OB Services for Uninsured and Undocumented Pregnant WomenDevelop partnerships and create a forum for planning,
delivery, and monitoring of services
Use ongoing studies of local need and capacity to inform planning
3. OB Services Reimbursement TaskforceImprove access to care, including sharing information, alternative
models of care, research on barriers to care, etc.Advocate for reimbursement of OB care that is adequate to cover
costs
Improving Practice
Recommendations from the floor lead to the creation of three new work groups to continue this work through 2008:
1. Monitoring Sentinel Events
2. Comparison of Costs and Reimbursement
3. Medical Liability Costs and Coverage
Improving Practice
MCFH recognized the ability to plan for OB services in Philadelphia should not be limited to understanding the births of
Philadelphia residents only
• Major city with some of the best hospitals• Major metropolitan area with a large suburban
population
Improving Practice
MCFH Evaluation Unit realized conversations by multiple partners were
based on different realities:
• Some partners were planning based only on Philadelphia city residents
• Some partners were planning based on “all patients” served by systems
Improving Practice
In order to inform planning moving forward, the MCFH Evaluation Unit analyzed city and non-city residents to determine what impact,
if any, non-city residents had on the OB system in Philadelphia
Improving Practice
• Birth record data for 2003-2007 were analyzed.– Data are received from the PA Dept of Health– Data reflect births in Philadelphia hospitals– Data were geocoded to indicate whether
births were to Philadelphia residents or to non-residents
– Data for all years were combined to minimize extreme sample size differences
Improving Practice
Births to non-residents average 3,000-4,000/year while births to residents average
22,000-23,000/year
Improving Practice
Chi-Square analysis compared residents and non-residents on several categorical measures.
Improving Practice
Non-residents were more likely:• To have gestational diabetes &/or gestational
hypertension• Vaginal bleeding and/or perineal lacerations • To have premature rupture of membranes• To have c-sections
Improving Practice
Non-residents were also more likely :• To have babies who are low birth weight and/or of
early gestational age• To have had infertility treatments• Have multiple births greater than twins• Be of advanced maternal age• Have babies requiring NICU admissions
Improving Practice
Philadelphia residents were more likely• To have had a previous pre-term birth• To experience precipitous labor• To have prolonged labor• To be teens
Improving PracticeConclusions• Analysis indicates differing patient needs and
issues for resident and non-resident women
• Differing needs and complications have the potential to impact capacity of OB units differently– E.g. if non-residents have more multiple births
requiring c-sections and NICU admits, the level of care and length of stay is much greater
Improving Practice
Obstetrical planning in Philadelphia should include planning for different populations with different needs as opposed to planning based only on data for resident births
Contact Information
Cynthia Line, Ph.D.
Research/Data Manager
Maternal, Child and Family Health
Philadelphia Department of Public Health
215-685-5264