Obstetric transport in rural settings: Referral and transport of pregnant patients in a state without a perinatal regionalized system of care

IF 3.1 2区医学 Q2 HEALTH CARE SCIENCES & SERVICES

Health Services Research Pub Date : 2024-08-05 DOI:10.1111/1475-6773.14365

Kaitlin Fertaly PhD, McKenzie Javorka PhD, Diane Brown MPH, Carly Holman MS, Megan Nelson MSW, Annie Glover PhD, MPH, MPA

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引用次数: 0

Abstract

Objective

To assess factors impacting obstetric transport and referral processes for pregnant patients experiencing an emergency in a rural state without a perinatal regionalized system of care.

Data Sources and Study Setting

Data is from Critical Access Hospitals (CAHs) without obstetric units and healthcare providers involved in obstetric care and transport at hospitals with varying levels of obstetric capacity in Montana.

Study Design

This mixed-methods study involved surveying CAHs without obstetric units about the hospitals' capacity for obstetric emergencies and transport policies. Survey data were collected from 32 of 34 CAHs without obstetric units (94% response rate) in the fall of 2021. Subsequent interviews were conducted in the fall and winter of 2022–2023 with 20 hospital and emergency medical services (EMS) personnel to provide further insights into the referral and transport process during obstetric emergencies.

Data Collection/Extraction Methods

Survey data were collected using REDCap; interviews were conducted via videoconference. We performed descriptive statistics and Fisher's exact tests for quantitative data. We analyzed qualitative data using a three-phase pragmatic analytic approach.

Principal Findings

The survey of CAHs found 12 of 32 facilities faced difficulties coordinating transport for pregnant patients. Qualitative data indicated this was often due to the state's decentralized transport system. Challenges identified through both quantitative and qualitative data included weather, securing a receiving facility/provider, and coordinating medical transport. Only 10 CAHs reported having written protocols for transporting pregnant patients; of those, four facilities had formal transfer agreements. Qualitative data emphasized variations in awareness and the utility of obstetric transport policies.

Conclusions

A decentralized transport system in a rural state can exacerbate existing challenges faced by providers arranging transport for pregnant patients during an obstetric emergency. State and interfacility policies could enhance the transport process for increased regionalization as well as increased support for and coordination of existing EMS.

查看原文本刊更多论文

农村地区的产科转运：在一个没有围产期区域化护理系统的州，孕妇病人的转诊和转运。

目的在一个没有围产期区域化医疗系统的农村地区，评估影响孕妇急诊转运和转诊流程的因素：数据来自蒙大拿州没有产科单位的重症监护医院（CAH）以及产科能力水平不一的医院中参与产科护理和转运的医疗服务提供者：这项混合方法研究包括对没有产科单位的 CAH 进行调查，了解医院的产科急诊能力和转运政策。2021 年秋季，从 34 家没有产科单元的 CAHs 中的 32 家（回复率 94%）收集了调查数据。随后在2022-2023年秋冬季对20名医院和紧急医疗服务（EMS）人员进行了访谈，以进一步了解产科急诊的转诊和转运流程：调查数据使用 REDCap 收集；访谈通过视频会议进行。我们对定量数据进行了描述性统计和费雪精确检验。我们采用三阶段实用分析方法对定性数据进行了分析：对 CAHs 的调查发现，32 家医疗机构中有 12 家在协调孕妇患者的转运方面遇到了困难。定性数据显示，这通常是由于该州分散的运输系统造成的。通过定量和定性数据发现，所面临的挑战包括天气、确保接收设施/医疗服务提供者以及协调医疗运送。仅有 10 家 CAH 报告称制定了转运怀孕患者的书面协议；其中 4 家机构签订了正式的转运协议。定性数据强调了对产科转运政策的认识和实用性方面的差异：结论：农村地区分散的转运系统可能会加剧医疗服务提供者在产科急诊中安排转运孕妇所面临的现有挑战。州政府和医疗机构间的政策可以加强转运过程，提高区域化程度，并加强对现有急救服务的支持和协调。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Health Services Research 医学-卫生保健

CiteScore

4.80

自引率

5.90%

发文量

193

审稿时长

4-8 weeks

期刊介绍： Health Services Research (HSR) is a peer-reviewed scholarly journal that provides researchers and public and private policymakers with the latest research findings, methods, and concepts related to the financing, organization, delivery, evaluation, and outcomes of health services. Rated as one of the top journals in the fields of health policy and services and health care administration, HSR publishes outstanding articles reporting the findings of original investigations that expand knowledge and understanding of the wide-ranging field of health care and that will help to improve the health of individuals and communities.