Vermont Business MagazineA new three-year study by Dartmouth-Hitchcock physician Timothy Fisher, MD, will seek to understand why nine rural New Hampshire hospitals have closed their maternity wards since 2000, outline the impacts of these closures, and provide policy makers and hospital leaders with recommendations to better serve women in these communities and others that may be at risk.
Funded by the Robert Wood Johnson Foundation, the New Hampshire study is one of 15 state-based projects to examine rural health trends in the 21stcentury. The RWJF Interdisciplinary Research Leaders program will provide up to $350,000 for salary support and project completion. Dr. Fisher will partner with Sarah Benatar, PhD, and Stacey McMorrow, PhD, from the Urban Institute in Washington DC, both of whom have extensive experience in studying patterns and outcomes of women’s health care.
The plight of rural hospitals is widespread in many rural states, including northern New England. Demographic shifts, recruitment and retention of maternity care providers, low reimbursement for services, and high costs of providing maternity care are among the drivers leading hospitals to shutter their labor and delivery units.
“More than half of all U.S. counties do not have OB/GYN doctors to serve pregnant women,” Fisher says. “It’s important that we have the resources in every county to support the care and education of women where they live.”
Fisher says the three-year study, in partnership with the Northern New England Perinatal Quality Improvement Network (NNEPQIN), will try to answer three questions:
- Why are hospital-based maternity wards closing in New Hampshire?
- What is the impact of these closures on pre-term births, cesarean sections, newborn health, and on emergency personnel and emergency rooms in hospitals?
- What are reasonable strategies to mitigate the impact of closures on rural communities?
Drs. Fisher, Benatar, and McMorrow will start by refining the research questions and methodology this winter. A daylong meeting in mid-November sponsored by NNEPQIN with more than 100 attendees from three states helped brainstorm the scope of the project. The study will focus on discovering the patterns leading up to maternity unit closures and assessing the impacts of these closures on mother and newborn health outcomes.
Data collection and interviews with women and families will begin next spring and a preliminary analysis will be shared with stakeholders by the winter of 2019-2020. Results are expected to be published in 2021.
“New Hampshire has a wealth of data already available to us in birth records and other public information,” Fisher says. “We plan to dig deeply for other data, talk with doctors and hospital leaders and, most important, with women who are impacted by these closings.”
Dartmouth-Hitchcock Medical Center Chief Medical Officer Dr. Maria Padin, board-certified in Obstetrics and Gynecology and who attended the conference, asked, “What do we need to change to deliver care for this rural population? How do we break the barriers down in our health systems and communities to facilitate the design of innovative care models that meet the needs of the mothers and children of New Hampshire? This needs to be a collective effort.”
“As we gather results and make our findings, we plan to engage with the major stakeholders whocontrol maternity care: the insurance companies who pay for these services, legislators and policy makers who regulate health systems, and the professionals who deliver care” Fisher says. “We need to be sure they understand the importance of what we need to do in the future to guarantee that mothers and babies in New Hampshire have the care needed to ensure good outcomes in order to live long, safe, productive lives.”
LEBANON, NH –DARTMOUTH-HITCHCOCK(D-H) 12.11.2018