Regionalization and survival outcomes for preemies

As I’m reading more about premature births, I’ve been coming across the concept of regionalization for neonatal care, which means that local hospitals send their mothers who are likely to have a pre-term birth to the big regional hospital that has a large department for high-risk women and also has a large neonatal intensive care unit. The here was that neonates do better at the regional hospitals than they do at the local hospitals.

In the opening summary of Preterm Birth: Causes, Consequences and Prevention (2007), the authors say that infants with very low birth weight have twice the rates of mortality at Level II centers than in Level III centers. in the 1970s, the March of Dimes pushed for regionalization, that is, getting the highest-risk neonates to the most specialized care centers, and that did result in an increase in survival rates by the early 1980s. However, by the end of the 80s, hospitals began using specialized facilities to compete with one another for patients. The sales pitch would be to the effect of, “We’re super-advanced here, so you can feel that much safer having a birth here (even if you’re not high-risk).” The thing is, though, that the opening of these specialized facilities didn’t always correspond to actual need from the number of premature babies, and facilities tend to be more effective when they are serving more than 15 babies at once (I’m assuming because it brings a larger population of specialists together).

This partially answers a question I’d had before, which was why so many Alaskans were turning up at Swedish Hospital in Seattle. For their sake, I kind of wished they could get care at home, but maybe that wouldn’t have helped them.

It also sheds a little light on the spat from earlier in the year between Mary Bridge and St. Joseph hospitals in Tacoma, when Mary Bridge opposed St. Joseph’s efforts to open a Level III NICU. The two hospitals are 15 blocks apart. Mary Bridge has the city’s most specialized NICU, but then St. Joseph wanted to get a five-bed Level III NICU opened so that they wouldn’t have to send all the highest-need babies to Mary Bridge or Seattle Children’s (25 miles away). Mary Bridge opposed the license. I wondered why, thinking it was just a turf-war thing, but maybe it has to do with the small size of St. Joseph’s facility. More reading to do….


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