Healthcare Policy/Economics
Poster Session 3
Anna Farooqi, BA (she/her/hers)
Texas Tech University Health Sciences Center
Amarillo, TX, United States
Alexander M. Friedman, MD
Columbia University
New York, NY, United States
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Nasim C. Sobhani, MD
Assistant Professor
University of California, San Francisco (UCSF)
San Francisco, CA, United States
Mary D'Alton, MD (she/her/hers)
Willard C. Rappleye Professor and Chair of the Department of Obstetrics and Gynecology
Columbia Presbyterian Medical Center
New York, NY, United States
Timothy Wen, MD,MPH (he/him/his)
Clinical Fellow
University of California, San Francisco (UCSF)
San Francisco, CA, United States
With an increase in maternal care deserts expected data on maternal transfers prior to birth is critical. Using national data, we sought to assess national trends, epidemiology, and adverse outcomes in this cohort.
Study Design:
Birth hospitalizations were identified in the 2010-2020 Nationwide Readmissions Database for this cross-sectional analysis. Transfers were defined as admissions to a separate hospital with a patient disposition of hospital transfer immediately prior to birth hospitalization. Trends analysis of maternal transport, outcomes by transfer status, and transfers to larger or teaching facilities was conducted using Joinpoint regression and expressed as annual average percent change (AAPC) and 95% confidence intervals (CI). Unadjusted and adjusted logistic regression models were fit to assess transfer status’s association with adverse clinical outcomes adjusting from demographic, clinical, and hospital characteristics.
Results:
Of 37.4 million birth hospitalizations, 3,521 (9.4 per 100,000 births) births required transfer prior to birth at a stable rate of 8.4 to 8.9 transfers per 100,000 births from 2010 to 2020. Rates of transfers to larger hospitals increased from 15.7% to 23.6% (AAPC 5.7%, 95% CI: 1.8%, 10.4%) while transfers to teaching hospitals decreased from 65.6% to 45.3% (AAPC -3.4%, 95% CI: -4.6%, -2.4%) during this time. Births requiring transfers had higher rates of clinical factors such as hypertensive disorders of pregnancy (38% vs. 10%), multiple gestation (8% vs. 2%) and obesity (19% vs. 8%). Transferred birth hospitalizations had higher prevalence and adjusted odds of complications including non-transfusion severe maternal morbidity, needing critical care procedures, and shock/sepsis (Table).
Conclusion:
Maternal transfers prior to birth are uncommon with a decreased trend of transfer to academic centers and disproportionate burden of adverse outcomes. As care continues to regionalize, maternal levels of care can aid in streamlining transfers and mitigating morbidity by enhancing coordination and appropriate resource allocation.