Thesis Format
Integrated Article
Degree
Master of Science
Program
Epidemiology and Biostatistics
Supervisor
Campbell, M. Karen
Abstract
Perinatal regionalization is a coordinated system that distributes perinatal services across hospitals within a region according to their level-of-care designation. While guided by a structured framework, its implementation varies widely, raising questions about the effectiveness of current systems in improving maternal and neonatal outcomes in an ever-evolving healthcare field. This thesis aimed to evaluate perinatal regionalization systems and their process outcomes through two studies. The first is a systematic review of global perinatal regionalization systems. Findings revealed that most high-risk births occurred in risk-appropriate facilities, with such deliveries associated with favourable outcomes, including reduced perinatal/neonatal/infant mortality. The second, an exploratory study using Ontario’s 2011–2019 Discharge Abstract Database to examine the distribution of birth hospitals by gestational age, demonstrated that most high-risk births, identified as preterm, occurred in hospitals within the top tertile of delivery volume. Together, these findings provide a comprehensive evaluation of how these systems function within today’s healthcare landscape.
Summary for Lay Audience
Perinatal regionalization is a coordinated system where perinatal care is distributed across healthcare facilities within a defined region based on level of care. These facilities range from lower-level hospitals providing basic care for low-risk pregnancies to higher-level hospitals providing specialized care for high-risk pregnancies. The main goal of perinatal regionalization is to identify high-risk pregnancies early and direct them to a facility capable of managing their level of risk, known as a risk-appropriate facility. Many countries have adopted this system due to its reported benefits, including improved neonatal outcomes. However, there is variation in how perinatal regionalization systems are implemented and limited research on how they are currently functioning. As the healthcare field evolves, it is important to continuously assess these systems to ensure that they are functioning as intended, particularly in ensuring that high-risk pregnancies are directed to risk-appropriate facilities.
The overall aim of this thesis was to evaluate perinatal regionalization systems using two studies: (1) a systematic review that assessed global perinatal regionalization systems and their process outcomes; and (2) an exploratory study that examined the delivery locations of infants in Ontario. Our systematic review revealed that most high-risk births were delivered in risk-appropriate facilities, and this was associated with favourable outcomes, including reduced perinatal/neonatal/infant mortality. Our exploratory study examined the distribution of births across hospitals in Ontario using Ontario’s 2011–2019 Discharge Abstract Database. Birth hospitals were grouped into tertiles based on their annual delivery volume, reflecting the structure of regionalized perinatal care. Furthermore, we classified births by gestational age, with preterm births identified as high-risk. The findings of this study align with those of our systematic review, revealing that most high-risk births occurred in hospitals within the top tertile of annual delivery volume. Together, the studies add to the limited research on perinatal regionalization by offering a comprehensive assessment of current perinatal regionalization systems. We anticipate that our findings will help healthcare providers better understand how perinatal regionalization systems are functioning within their region. Future studies should investigate factors that support these systems to determine how to best optimize them, ensuring patients are promptly directed to the most appropriate facility for delivery.
Recommended Citation
Dao, Tina, "Risk-Appropriate Care for High-risk Births: An Evaluation of Process Outcomes of Perinatal Regionalization Systems" (2025). Electronic Thesis and Dissertation Repository. 10892.
https://ir.lib.uwo.ca/etd/10892
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