{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,23]],"date-time":"2025-07-23T12:41:16Z","timestamp":1753274476500,"version":"3.28.0"},"reference-count":7,"publisher":"Georg Thieme Verlag KG","issue":"S 01","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Am J Perinatol"],"published-print":{"date-parts":[[2021,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>\n          Objective\u2003This study aimed to analyze whether hospital safety-net burden status is associated with increased risk for severe maternal morbidity (SMM) and postpartum readmissions.<\/jats:p><jats:p>\n          Study Design\u2003The 2010 to 2014 Nationwide Readmissions Database was utilized for this retrospective cohort study. Hospitals were categorized as high-burden hospitals (25% of hospitals with the highest safety-net burden), medium-burden hospitals (50% of hospitals with intermediate safety-net burden), and low-burden hospitals (25% of hospitals with the lowest safety-net burden) based on the proportions of Medicaid or uninsured patients. Risk for (1) SMM, (2) 60-day postpartum readmissions, and (3) SMM during postpartum readmissions was analyzed. Unadjusted and adjusted log-linear regression models were performed, respectively, for these outcomes with unadjusted risk ratio (RR) and adjusted RR (aRR) as measures of effect. Adjusted models included demographic, hospital, and clinical factors.<\/jats:p><jats:p>\n          Results\u2003High-burden safety-net status was associated with increased risk for SMM compared with low-burden safety-net status in both unadjusted (RR: 1.51, 95% confidence interval [CI]: 1.50\u20131.53) and adjusted analyses (aRR: 1.27, 95% CI: 1.25\u20131.30). High-burden status was also associated with increased risk for readmissions in unadjusted analyses (RR: 1.42, 95% CI: 1.40\u20131.44), although this risk was attenuated in adjusted analyses (aRR: 1.07, 95% CI: 1.06\u20131.08). High-burden status was associated with significantly increased risk for readmission for uterine infections, hypertensive diseases of pregnancy, and psychiatric diagnoses. High-burden status was not associated with severe morbidity during readmissions in adjusted or unadjusted analyses (RR: 1.02, 95% CI: 0.98\u20131.05; aRR: 0.95, 95% CI: 0.92\u20130.99).<\/jats:p><jats:p>\n          Conclusion\u2003This study found that high safety-net burden hospitals may be a higher risk setting for obstetric care. Improvement of outcomes in high-burden settings may be important in overall efforts to reduce maternal risk.<\/jats:p>","DOI":"10.1055\/s-0040-1710544","type":"journal-article","created":{"date-parts":[[2020,5,5]],"date-time":"2020-05-05T22:47:10Z","timestamp":1588718830000},"page":"e359-e366","source":"Crossref","is-referenced-by-count":4,"special_numbering":"S","title":["Hospital Safety-Net Burden and Risk for Readmissions and Severe Maternal Morbidity"],"prefix":"10.1055","volume":"38","author":[{"given":"Lilian P.","family":"McKinley","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Timothy","family":"Wen","sequence":"additional","affiliation":[{"name":"Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cynthia","family":"Gyamfi-Bannerman","sequence":"additional","affiliation":[{"name":"Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jason D.","family":"Wright","sequence":"additional","affiliation":[{"name":"Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dena","family":"Goffman","sequence":"additional","affiliation":[{"name":"Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jean-Ju","family":"Sheen","sequence":"additional","affiliation":[{"name":"Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mary E.","family":"D'Alton","sequence":"additional","affiliation":[{"name":"Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexander M.","family":"Friedman","sequence":"additional","affiliation":[{"name":"Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2020,5,5]]},"reference":[{"issue":"03","key":"ref1","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1001\/jamasurg.2013.3566","article-title":"Failure to rescue in safety-net hospitals: availability of hospital resources and differences in performance","volume":"149","author":"E Wakeam","year":"2014","journal-title":"JAMA Surg"},{"key":"ref3","doi-asserted-by":"crossref","first-page":"e284","DOI":"10.1016\/j.wneu.2018.07.134","article-title":"Safety-net hospitals have higher complication and mortality rates in the neurosurgical management of traumatic brain injuries","volume":"119","author":"J Bakhsheshian","year":"2018","journal-title":"World Neurosurg"},{"issue":"02","key":"ref4","doi-asserted-by":"crossref","first-page":"346","DOI":"10.1002\/cncr.31046","article-title":"The site of care matters: an examination of the relationship between high Medicaid burden hospitals and the use, cost, and complications of immediate breast reconstruction after mastectomy","volume":"124","author":"A C Offodile II","year":"2018","journal-title":"Cancer"},{"issue":"04","key":"ref6","doi-asserted-by":"crossref","first-page":"469","DOI":"10.1007\/s10995-007-0256-6","article-title":"An enhanced method for identifying obstetric deliveries: implications for estimating maternal morbidity","volume":"12","author":"E V Kuklina","year":"2008","journal-title":"Matern Child Health J"},{"issue":"09","key":"ref7","doi-asserted-by":"crossref","first-page":"1204","DOI":"10.1038\/s41372-019-0426-6","article-title":"Patient and hospital characteristics associated with severe maternal morbidity among postpartum readmissions","volume":"39","author":"P D Johnson","year":"2019","journal-title":"J Perinatol"},{"issue":"05","key":"ref8","doi-asserted-by":"crossref","first-page":"455","DOI":"10.1001\/jamapediatrics.2019.0241","article-title":"Racial segregation and inequality in the neonatal intensive care unit for very low-birth-weight and very preterm infants","volume":"173","author":"J D Horbar","year":"2019","journal-title":"JAMA Pediatr"},{"issue":"12","key":"ref9","doi-asserted-by":"crossref","first-page":"2206","DOI":"10.2105\/AJPH.2004.046730","article-title":"Mortality among very low-birthweight infants in hospitals serving minority populations","volume":"95","author":"L S Morales","year":"2005","journal-title":"Am J Public Health"}],"container-title":["American Journal of Perinatology"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/s-0040-1710544.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,11,5]],"date-time":"2024-11-05T16:04:25Z","timestamp":1730822665000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/s-0040-1710544"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,5,5]]},"references-count":7,"journal-issue":{"issue":"S 01","published-online":{"date-parts":[[2021,8,27]]},"published-print":{"date-parts":[[2021,8]]}},"URL":"https:\/\/doi.org\/10.1055\/s-0040-1710544","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0735-1631","1098-8785"],"issn-type":[{"type":"print","value":"0735-1631"},{"type":"electronic","value":"1098-8785"}],"subject":[],"published":{"date-parts":[[2020,5,5]]}}}