Neonatal Resuscitation Success in Rural Hospitals Final rept. (July 1, 2004-May 31, 2005)

摘要

The purpose of this research is to describe rural maternity units (preparedness), healthcare providers practicing in rural maternity units (readiness) and the neonates born with rural maternity units (outcomes). Psychometric characteristics of the instruments used to measure these variables were determined. A hierarchical generalized linear model linking preparedness, readiness, and outcome was estimated. Scope: Hulme & Blegen (1999) found that rural women have worse birth outcomes than their urban/suburban counterparts. Differential prevalences of individual prenatal risk factors may explain some variation. However, little attention has been directed toward evaluating variation in care at the time of delivery. Twenty-six hospitals with level-1 perinatal services within 2 Midwestern states particpated. Healthcare professionals (N = 181) provided information about their knowledge, comfort, and experiences performing neonatal resuscitation. Hospital birthlogs were used to obtain neonatal data (N = 4,005). Donabedians (1966) classic model for evaluation in healthcare posits that 3 levels of a health system provide information about quality: structure, process, and outcome. The fundamental idea is that quality of structure and process explains variation in patient outcomes. A descriptive, cross-sectional study with a hierarchical data structure was utilized. Findings indicate that higher levels of hospital preparedness increase the odds of successful neonatal resuscitation (outcome). Findings can be used to advance theory about structure and function of health services systems of care for newborns in rural areas.