925: Evaluating the association between access to MFM physicians and maternal morbidity

Abstract

Maternal morbidity and mortality are rising in the US. The importance of Maternal-Fetal Medicine (MFM) physicians as a critical factor in reversing this alarming trend has been suggested. Our objective was to 1) describe the availability of MFM access across a national sample of hospitals and 2) to evaluate the association between access to MFM services and maternal morbidity. We collected data regarding institutional characteristics using a telephone survey of labor and delivery leaders from May to November, 2015. These survey responses were linked to discharge data (from Statewide Inpatient Databases (SID)) of 247,383 births within 237 hospitals in nine US states in 2013. The primary outcome for this analysis was the rate of severe maternal morbidity as described by Bateman et al. Generalized logistic regression models were used to examine the associations between hospitals’ MFM access and the risk of severe maternal morbidity after adjusting for clustering by hospital, delivery volume and patient-level characteristics. The majority of hospitals surveyed had the ability to obtain an MFM consultation (Table). However, most did not have access to in-person day and night consultative services. When 24/7 consultation was not available, delivery in a hospital that had MFM access via telemedicine was associated with a lower odds of severe maternal morbidity. This analysis provides evidence that the inability to access MFM consultative services is associated with greater odds of maternal morbidity. Further rigorous evaluation of models of MFM access and their association with patient outcomes is necessary to develop optimal models of care delivery.