Effect of Travel Distances on Access to Obstetric Care and Birth Outcomes in Rural Communities
Many health services providers, researchers and policy-makers are concerned that women living in rural communities may not have sufficient access to local obstetric care. Underlying this concern are statistics that show a downward trend in the number of obstetric care providers in rural areas and a significant gap between the number of obstetric care providers per capita in rural and non-rural areas. Scarce resources, low and declining birth rates and difficulties in attracting physicians to rural areas make it impossible and perhaps also unnecessary for all women living in rural communities to have local access to obstetric care. The costs of lack of local access to obstetric care, on the other hand, could range from inconvenience for patients to compromised health outcomes. This study assesses whether the availability of obstetric providers in rural areas is sufficient to meet the need for obstetric care by measuring the distance patients must travel to obtain prenatal care and delivery and by examining health outcomes related to labor and delivery. Health outcome measures include the likelihood of an expectant mother is admitted into a hospital through the emergency department and complications and mortality rates among both mothers and babies.
The two main sources of data for this study are the National Ambulatory Medical Care Survey (NAMCS) and the State Inpatient Database (SID). We have selected a group of states from the SID that is nationally representative and allows us to examine outcomes for different levels of rurality. We have extracted patient and provider zip codes from the 2004 NAMCS and the 2004 SID for prenatal care and labor and delivery, respectively. GIS techniques are then applied to zip codes to calculate distances between the population center of mass of a patient’s zip code and the population center of mass of the zip code of the physician’s office or hospital where that patient receives obstetric care. Using the admission source codes, diagnosis codes, and procedure codes in the 2004 SID, we identify expectant mothers who were admitted into a hospital for labor and delivery through the emergency department and complications and mortality related to labor and delivery among all mothers and babies. We are estimating logistic regressions to examine whether health outcomes are correlated with travel distances, focusing on comparisons of outcomes between rural and non-rural areas to examine whether differences in travel distance to obtain obstetric care is associated with compromised patient health in rural areas.
Findings from this study will shed light on whether there is a shortage of obstetric providers in rural communities and, in doing so, help policy-makers determine whether or not measures should be taken to improve access to obstetric care in rural America. Our findings may also provide useful guidance concerning how resources for enhancing access to care should be allocated.
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