Obstetric Care Provider Density and Pregnancy Outcomes. Abstract, ExecutiveSummary and Final Report

摘要

Local physician shortages may impede efforts to improve prenatal care in the U.S.The authors used Tennessee vital records to conduct a retrospective cohort study of the association between obstetrician density and adequate prenatal care (Kessner index), birth weight less than 1500 g (VLBW), and neonatal death among live preterm (less than 37 weeks) births. Although women in all counties with obstetrician provider density less than 5/10,000 had increased odds (O.R.(95% C.I.) = 1.51(1.44-1.60)) of adequate prenatal care, there was no dose-reponse: women in counties with no obstetricians (O.R. = 1.29(1.20-1.40)) had lower odds of this outcome than did women with densities of 4/10,000 (O.R. = 1.51(1.40-1.62)). There was no association between VLBW and provider density (O.R. for less than 5/10,000 = 0.94(0.82-1.08)). When these counties were removed from the analysis, there was no association between neonatal deaths in live preterm births and provider density (O.R. = 0.96(0.59-1.57)). These data suggest that provider density was not a major determinant of adequacy of prenatal care and pregnancy outcomes.