Hospital Factors and Nontransfer of Small Babies: A Marker of Deregionalized Perinatal Care?

OBJECTIVES:: Our purpose was to examine the contribution of hospital factors (e.g., reimbursement sources, teaching status) to the rate of nontransfer of <1250?g infants born in nontertiary hospitals in Illinois. We chose nontransfer as a marker of the extent to which there have been structural changes in the regionalized perinatal care system in Illinois. STUDY DESIGN:: Using data from live birth certificates (1989-1996), from the American Hospital Association's Annual Survey of Hospitals (1990 to 1996), and Illinois hospital discharge records (1992 to 1996), we simultaneously assessed the effect of hospital and individual factors on nontransfer of infants <1250?g (n=2904). RESULTS:: When adjusted for individual risk factors, several hospital factors were associated with nontransfer. These include birth in a Level II+hospital (odds ratios(OR) 3.75; 95% CI 2.29, 5.29), high Medicaid revenues (OR 1.97; 95% CI 1.58, 2.47), high HMO revenues (OR 1.39; 95% CI 1.11, 2.28), and status as a teaching hospital (OR 1.63; 95% CI 1.30, 2.09). CONCLUSIONS:: This study suggests that there should be careful consideration of the role of hospital factors in perinatal deregionalization in order to preserve the improvements in maternal and infant outcomes associated with regionalized perinatal care.Journal of Perinatology (2004) 24, 351-359. doi:10.1038/sj.jp.7211101 Published online 15 April 2004 [ABSTRACT FROM AUTHOR]