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Obstetric Services and Quality among Critical Access, Rural, and Urban Hospitals in Nine States

Kozhimannil, K., Hung, P., McClellan, M., Casey, M., Prasad, S., Moscovice, I.

Publication Date: June 2013

This study assessed and compared the characteristics and quality of obstetric care in Critical Access Hospitals (CAHs), other rural hospitals, and their urban counterparts.

Key Findings

  • Women who gave birth in CAHs and other rural hospitals in 2010 were younger on average and had lower rates of clinical complications than those who gave birth in urban hospitals.
  • CAHs compared favorably with other rural and urban hospitals on obstetric care quality measures including cesarean delivery among low-risk women, cesarean delivery without medical indication, and labor induction with medical indication.
  • Medicaid covered 49 percent of births in CAHs and 56 percent of births in other rural hospitals, compared to 41 percent of births in urban hospitals.
  • The percentage of CAHs, other rural hospitals, and urban hospitals providing obstetric services in 2010 varied significantly across states, with the greatest variation among CAHs.
  • Half of the CAHs in this study’s sample provided obstetric services in 2010, likely a higher rate than all CAHs nationwide due to the selection criteria for the sample.

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