The regionalization of perinatal care in Wales and Washington State

• Published in: American journal of public health (1971) Vol. 86; no. 7; pp. 1011 - 1015
• Main Authors: Rosenblatt, R A, Macfarlane, A, Dawson, A J, Cartlidge, P H, Larson, E H, Hart, L G
• Format: Journal Article
• Language: English
• Published: Washington, DC Am Public Health Assoc 01.07.1996; American Public Health Association
• Subjects: Babies; Biological and medical sciences; Birth Certificates; Birth Weight; Births; Comparative studies; Comparison; Death Certificates; General aspects; Gestational age; Health Services Research; Health systems. Social services; Humans; Infant Mortality; Infant, Newborn; Intensive care; Intensive Care, Neonatal - organization & administration; Linked Data; Maternal child nursing; Maternal Health Services - organization & administration; Medical referrals; Medical sciences; Neonatal care; Newborn babies; Obstetrics; Pediatrics; Perinatal care; Perinatology - organization & administration; Premature babies; Public health; Public health. Hygiene; Public health. Hygiene-occupational medicine; Referral and Consultation; Regional Medical Programs - organization & administration; Regional variations; Wales; Wales - epidemiology; Washington - epidemiology; Washington State; Great Britain; United States; Europe; America; Wales; United Kingdom; North America; Washington; United Kingdom > UK; USA; Human; Health system; Newborn; Mortality; Public health organization; Quality; Perinatal; Regional planning; Comparative study; Public health; Care
• ISSN: 0090-0036; 1541-0048
• DOI: 10.2105/AJPH.86.7.1011

The purpose of this study was to compare perinatal regionalization and neonatal mortality in Wales and Washington State. The 28 hospitals in Wales and the 80 hospitals in Washington State that offered maternity services and the 218,326 births that occurred in these hospitals in 1989 and 1990 were studied. Surveys were used to identify the neonatal technology and the referral policies of each hospital, and linked data from birth and death certificates were used to examine birthweight-specific neonatal mortality rates for all babies born in these hospitals. Welsh district general hospitals (broadly equivalent to Level II perinatal centers in the United States) have more sophisticated neonatal technology than their Washington State counterparts and appear less likely to refer small or preterm babies to regional or subregional centers. Neonatal mortality rates were quite similar in the two settings. Perinatal care in Wales appears to be less regionalized than in a similar region in the United States. The relative lack of perinatal regionalization in Wales may contribute to duplication and underutilization of expensive neonatal technologies. National health care systems do not, in and of themselves, lead to optimal regionalization of services.