A Different Model of Care: High-Risk Obstetrical Services in a Rural Midwestern State [14K

Abstract

INTRODUCTION: Rural obstetrical patients are more likely to experience adverse pregnancy and birth outcomes compared to their urban counterparts. Serving an underserved population in a Midwestern state, a rural hospital with 300 deliveries per year experienced a high rate of pregnancies complicated by gestational diabetes. The purpose of this study was to assess women's perceptions of obstetrical services in this area. METHODS: Through collaboration of the hospital, medical school, and a regional healthcare system, a rural maternal-fetal medicine (MFM) clinic was established. Once a month, a MFM physician and his staff travel by plane to see high-risk pregnant patients. Self-reported surveys were administered to these patients. Questions focused on quality of care, communication, patient adherence, support services, barriers to care, health status, and demographic characteristics. Data were collected between January and April, 2016. Descriptive analyses were conducted. RESULTS: Of the 31 distributed surveys, 26 pregnant women completed the survey. The majority of respondents were non-Hispanic white (44%) or Hispanic (40%), a high school graduate (31%), WIC enrolled (58%), and earned less than $25,000/year (54%). Women's average age was 29 with an average body mass index of 29.7 three months prior to pregnancy. Overall, women reported being satisfied with the quality of care, identified un/underinsurance as barriers to care, and expressed a need for additional support services. CONCLUSION: This study is a first step toward enhancing the quality of care provided to underserved, rural women with high-risk pregnancies. Follow-up studies are needed to improve the delivery of specialized rural healthcare services.