Access to risk-appropriate hospital care and disparities in neonatal outcomes in racial/ethnic groups and rural-urban populations

Abstract

Variations in infant and neonatal mortality continue to persist in the United States and in other countries based on both socio-demographic characteristics, such as race and ethnicity, and geographic location. One potential driver of these differences is variations in access to risk-appropriate delivery care. The purpose of this article is to present the importance of delivery hospitals on neonatal outcomes, discuss variation in access to these hospitals for high-risk infants and their mothers, and to provide insight into drivers for differences in access to high-quality perinatal care using the available literature. This review also illustrates the lack of information on a number of topics that are crucial to the development of evidence-based interventions to improve access to appropriate delivery hospital services and thus optimize the outcomes of high-risk mothers and their newborns.

Conflict of interest statement

Declaration of Competing Interest The authors report no proprietary or commercial interest in any product mentioned or concept discussed in this article.

Copyright © 2021 Elsevier Inc. All rights reserved.

Figures

Figure 1:

Donabedian framework describing the impact of structure and process on patient outcomes. Here, structure of care, typically in perinatal medicine defined as a maternal or neonatal level of care, influences the processes of care delivered to an infant, which then influence the outcome of an infant. Quality of care at a specific hospital may modify these associations, while infant characteristics may influence where an infant receives care, what processes of care may be delivered, and the infant’s outcome.

Figure 2:

Anderson-Aday behavioral model of health service use for perinatal health care access. Patient factors; community, hospital, and market factors; and state policies interact to determine a patient’s potential access to risk-appropriate care; a patient’s realized access to risk-appropriate care; and an infant’s outcome as modified by the Donabedian framework highlighted in Figure 1.