Adapting Obstetric-Capacity Assessments to a Rural Context to Drive System Improvements [ID: 1375979

Abstract

INTRODUCTION: As part of its Health Resources and Services Administration Maternal Health Innovation, Centers for Disease Control and Prevention (CDC) ERASE MM, and the American College of Obstetricians and Gynecologists Alliance for Innovation on Maternal Health (AIM) awards, Montana assessed capacity to provide risk-appropriate care in Montana's hospitals with labor and delivery (L&D) units as well as critical access hospitals (CAHs) without L&D units that serve remote communities in maternity care deserts. METHODS: Montana conducted the CDC LOCATe assessment in 96% (N=25) of hospitals with an L&D and adapted an assessment used internationally by the World Health Organization to assess emergency obstetric capacity in 94% of CAHs without an L&D. Surveys were conducted in REDCap, and the research team provided facilities with technical support in their completion of the assessments. RESULTS: While half of CAHs without L&D reported an emergency delivery in the last 2 years, just one reported capacity to perform all services necessary to safely manage emergency deliveries. Two-thirds of facilities without L&D units did not have a written transport protocol. In hospitals with L&D who conducted the LOCATe assessment, nearly half (48%) overestimated the level of maternal health care that they were able to provide. Ultrasound and maternal-fetal medicine were the most common capacity insufficiencies. CONCLUSION: The system assessments revealed specific interventions that can expand capacity for quality obstetric care in a rural state like Montana, such as simulation training, adoption of AIM safety bundles through the perinatal quality collaborative, and enhanced access to ultrasound and maternal-fetal medicine services through telemedicine. National assessments like LOCATe should be adapted for the rural context to facilitate targeted resource investments.