This project will examine obstetric care quality and perinatal safety in rural U.S. hospitals nationally, with a focus on rural hospitals in a nationally representative group of eight states. We will improve upon prior research by distinguishing elective obstetric procedures (e.g., labor induction, cesarean section), paying explicit attention to rural relevance in a broader range of measures, and analyzing quality-related policy implications. Using hospital discharge data from Healthcare Cost and Utilization Project national and state databases, we will measure obstetric care quality related to delivery mode, elective procedures, and perinatal safety. We will examine longitudinal trends in these outcomes and characterize outcomes for types of rural hospitals (including CAHs) and for different levels of rurality. We will also identify patient and hospital-level predictors of high or low quality.
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