Key result
High-burden hospital safety-net status was associated with an increased risk for severe maternal morbidity compared with low-burden status.
Why the study?
Does care at high-burden safety-net hospitals increase the risk of severe maternal morbidity and postpartum readmissions compared to low-burden hospitals?
Cohort
Yes
Does care at high-burden safety-net hospitals increase the risk of severe maternal morbidity and postpartum readmissions compared to low-burden hospitals?
High safety-net burden hospitals are associated with an increased risk of severe maternal morbidity and postpartum readmissions, highlighting them as higher-risk settings for obstetric care.
Answers are grounded in this paper and cite their sources.
May indicate care disparities at safety-net hospitals; leaves open causal factors and intervention targets for prospective study.
OBJECTIVE: This study aimed to analyze whether hospital safety-net burden status is associated with increased risk for severe maternal morbidity (SMM) and postpartum readmissions. STUDY DESIGN: The 2010 to 2014 Nationwide Readmissions Database was utilized for this retrospective cohort study. Hospitals were categorized as high-burden hospitals (25% of hospitals with the highest safety-net burden), medium-burden hospitals (50% of hospitals with intermediate safety-net burden), and low-burden hospitals (25% of hospitals with the lowest safety-net burden) based on the proportions of Medicaid or uninsured patients. Risk for (1) SMM, (2) 60-day postpartum readmissions, and (3) SMM during postpartum readmissions was analyzed. Unadjusted and adjusted log-linear regression models were performed, respectively, for these outcomes with unadjusted risk ratio (RR) and adjusted RR (aRR) as measures of effect. Adjusted models included demographic, hospital, and clinical factors. RESULTS: High-burden safety-net status was associated with increased risk for SMM compared with low-burden safety-net status in both unadjusted (RR: 1.51, 95% confidence interval [CI]: 1.50-1.53) and adjusted analyses (aRR: 1.27, 95% CI: 1.25-1.30). High-burden status was also associated with increased risk for readmissions in unadjusted analyses (RR: 1.42, 95% CI: 1.40-1.44), although this risk was attenuated in adjusted analyses (aRR: 1.07, 95% CI: 1.06-1.08). High-burden status was associated with significantly increased risk for readmission for uterine infections, hypertensive diseases of pregnancy, and psychiatric diagnoses. High-burden status was not associated with severe morbidity during readmissions in adjusted or unadjusted analyses (RR: 1.02, 95% CI: 0.98-1.05; aRR: 0.95, 95% CI: 0.92-0.99). CONCLUSION: This study found that high safety-net burden hospitals may be a higher risk setting for obstetric care. Improvement of outcomes in high-burden settings may be important in overall efforts to reduce maternal risk.
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McKinley et al. (2020) conducted a cohort in Severe maternal morbidity and postpartum readmissions. High hospital safety-net burden vs. Low hospital safety-net burden was evaluated on Severe maternal morbidity (SMM) (aRR 1.27, 95% CI 1.25-1.30). High-burden hospital safety-net status was associated with an increased risk for severe maternal morbidity compared with low-burden status.
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