21 Services and safety-net burden of Black-serving hospitals and related Severe Maternal Morbidity

Abstract

More detailed evaluation of hospital factors related to obstetric outcomes may be important in understanding disparities. We aimed to examine detailed characteristics of Black-serving hospitals and associated risk for severe maternal morbidity (SMM). In this cross-sectional study, we linked the 2010-2011 Nationwide Inpatient Sample and the 2013 American Hospital Association Annual Survey databases. Delivery hospitalizations occurring to women 15-54 years of age were identified. The proportions of non-Hispanic Black (nHB) women within a hospital were categorized into quartiles, and hospital factors such as specialized medical, surgical and safety net services were compared across these quartiles. Log-linear models based on the Poisson distribution, with Black-serving hospital (term previously described) quartile as the primary exposure and SMM as the outcome were performed with unadjusted and adjusted risk ratios (aRR) as measures of effect. Overall 965,202 deliveries from 430 hospitals met inclusion criteria and were included in the analysis. By quartile, nHB patients accounted for 1.3%, 5.4%, 13.4%, and 33.8% of patients. Many services were less common in the lowest compared to the highest Black-serving hospital quartile including cardiac intensive care (48.9% versus 74.5%), neonatal intensive care (28.9% versus 64.9%), pediatric intensive care in (20.0% versus 45.7%), and HIV/AIDS services (36.3% versus 71.3%) (Table 1). Safety-net services were more common at Black-serving hospitals as was Medicaid payer. Following adjustment, the lowest Black-serving hospital quartile carried the lowest risk for SMM. However, SMM risks were similar across other quartiles: 2nd (aRR 1.23, 95% CI 1.14, 1.34), 3rd (aRR 1.12, 95% 1.02, 1.23), and 4th (aRR 1.05, 95% CI 0.94, 1.18) (Table 2). Black-serving hospitals were more likely to provide a range of specialized medical and surgical services and to have a higher safety-net burden. Case-mix associated with specialized services and Medicaid burden may account for some of the maternal risk associated with Black-serving hospitals.View Large Image Figure ViewerDownload Hi-res image Download (PPT)