{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T17:30:26Z","timestamp":1777915826415,"version":"3.51.4"},"reference-count":42,"publisher":"SAGE Publications","issue":"10","license":[{"start":{"date-parts":[[2009,10,1]],"date-time":"2009-10-01T00:00:00Z","timestamp":1254355200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Journal of Women's Health"],"published-print":{"date-parts":[[2009,10]]},"abstract":"<jats:sec>\n                    <jats:title>Objective:<\/jats:title>\n                    <jats:p>Efforts to improve health care outcomes in the United States have led some organizations to recommend specific hospital settings or case volumes for complex medical diagnoses and procedures. But there are few studies of the effect of setting and volume on maternal outcomes, particularly in complicated conditions, such as diabetes. Our objective was to estimate the effect of hospital setting and volume on childbirth morbidity and length of stay in pregnancies complicated by type 2 and gestational diabetes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>We analyzed Maryland hospital discharge data during 1999\u20132004. The dependent variables were primary cesarean delivery, episiotomy, a composite variable for severe maternal morbidity, and hospital length of stay. The independent variables were hospital setting (community, non-teaching hospitals, community, teaching hospitals, and academic medical centers) and tertiles of annual hospital diabetes delivery volume. Multivariable regression analysis was used to assess the relation of hospital setting with each outcome, adjusting for hospital volume and maternal case mix.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>5,507 deliveries with type 2 (15%) and gestational (85%) diabetes were analyzed. Primary cesarean delivery rates among women with any diabetes did not vary across settings. After adjustment for volume and patient case mix, the likelihood of severe maternal morbidity was higher among deliveries at academic centers compared to community, non-teaching hospitals (odds ratio [OR], 2.1; 95% confidence interval: 1.0, 4.2). Academic centers had a protective effect (OR, 0.3; 95% CI: 0.2, 0.7) and community teaching hospitals had a borderline protective effect (OR, 0.8; 95% CI: 0.7, 1.0) on episiotomy, compared to community, non-teaching hospitals. Length of stay was greater at academic centers and community, teaching hospitals compared to community, non-teaching hospitals (5.4 days, 3.5 days vs. 2.8 days, respectively). We did not identify an independent association between hospital diabetes volume and clinical outcomes after adjustment for case mix.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Among women with type 2 and gestational diabetes, hospital setting is associated with a higher likelihood of severe maternal morbidity and length of stay, independent of volume. Patient case mix accounts for some of the variation across settings. The volume-outcome relationship found with other complex medical conditions or procedures was not found among diabetic pregnancies. Further investigations are needed to explain variations in outcomes across hospital settings and volumes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1089\/jwh.2008.1114","type":"journal-article","created":{"date-parts":[[2009,9,18]],"date-time":"2009-09-18T11:03:20Z","timestamp":1253271800000},"page":"1567-1576","source":"Crossref","is-referenced-by-count":12,"title":["Effect of Hospital Setting and Volume on Clinical Outcomes in Women with Gestational and Type 2 Diabetes Mellitus"],"prefix":"10.1177","volume":"18","author":[{"given":"W.K.","family":"Nicholson","sequence":"first","affiliation":[{"name":"Johns Hopkins School of Medicine"},{"name":"Johns Hopkins Bloomberg School of Public Health"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"F.","family":"Witter","sequence":"additional","affiliation":[{"name":"Johns Hopkins School of Medicine"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"N.R.","family":"Powe","sequence":"additional","affiliation":[{"name":"Johns Hopkins School of Medicine"},{"name":"Johns Hopkins School of Medicine"},{"name":"Johns Hopkins Bloomberg School of Public Health"},{"name":"Johns Hopkins Bloomberg School of Public Health"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2009,10,1]]},"reference":[{"key":"e_1_3_3_2_2","unstructured":"LeapFrog Group. https:\/\/leapfrog.medstat.com. 2009 February 28."},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1001\/archsurg.138.1.41"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0003-4975(01)02781-3"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199905273402106"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199402103300607"},{"key":"e_1_3_3_7_2","first-page":"28","article-title":"Hospital volume and surgical mortality in the United States","volume":"340","author":"Birkmeyer JD","year":"2002","unstructured":"Birkmeyer JD, , Siewers AE, , Finlayson FV et al. Hospital volume and surgical mortality in the United States. N Engl J Med, 2002; 340:28\u201337.","journal-title":"N Engl J Med"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMsa035205"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMsa065029"},{"key":"e_1_3_3_10_2","first-page":"567","article-title":"Effect of academic affiliation and obstetric volume on clinical outcome and cost of childbirth","volume":"97","author":"Garcia Francisco AR","year":"2001","unstructured":"Garcia Francisco AR, , Miller H, , Huggins GR et al. Effect of academic affiliation and obstetric volume on clinical outcome and cost of childbirth. Obstet Gynecol, 2001; 97:567\u2013576.","journal-title":"Obstet Gynecol"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1136\/jech.48.4.400"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2005.00794.x"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kwm363"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2006.06.020"},{"key":"e_1_3_3_15_2","unstructured":"Centers for Disease Control and Prevention. Diabetes and women's health across the lifespan. 2005. www.cdc.gov\/diabetes. 2009 February 27."},{"key":"e_1_3_3_16_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0707943"},{"key":"e_1_3_3_17_2","doi-asserted-by":"publisher","DOI":"10.2337\/dc07-2345"},{"key":"e_1_3_3_18_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(02)08599-9"},{"key":"e_1_3_3_19_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.AOG.0000113623.18286.20"},{"key":"e_1_3_3_20_2","doi-asserted-by":"publisher","DOI":"10.2337\/diacare.29.02.06.dc05-1482"},{"key":"e_1_3_3_21_2","unstructured":"Maryland Health Care Commission hospital discharge data. www.hscrc.state.md.us\/casemix. 2009 August 1."},{"key":"e_1_3_3_22_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1091-255X(98)80098-X"},{"key":"e_1_3_3_23_2","doi-asserted-by":"publisher","DOI":"10.1001\/archpsyc.63.3.267"},{"key":"e_1_3_3_24_2","volume-title":"International Classfication of diseases\u2014clinical modification","year":"2002","unstructured":"International Classfication of diseases\u2014clinical modification. Salt Lake City, UT: Med-Index Publications, 2002."},{"key":"e_1_3_3_25_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.AOG.0000128045.50439.89"},{"key":"e_1_3_3_26_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.293.17.2141"},{"key":"e_1_3_3_27_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.AOG.0000188387.88032.41"},{"key":"e_1_3_3_28_2","doi-asserted-by":"publisher","DOI":"10.1258\/rsmvasc.12.1.51"},{"key":"e_1_3_3_29_2","volume-title":"Applied logistic regression","author":"Hosmer DW","year":"1989","unstructured":"Hosmer DW, , Lemeshow S. Applied logistic regression. New York: John Wiley, 1989."},{"key":"e_1_3_3_30_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1748-0361.2000.tb00447.x"},{"key":"e_1_3_3_31_2","first-page":"1257","article-title":"Does delivery volume of family physicians predict maternal and newborn outcome?","volume":"166","author":"Klein MC","year":"2002","unstructured":"Klein MC, , Spence A, , Kaczorowski J et al. Does delivery volume of family physicians predict maternal and newborn outcome? CMAJ, 2002; 166:1257\u20131263.","journal-title":"CMAJ"},{"key":"e_1_3_3_32_2","doi-asserted-by":"publisher","DOI":"10.1097\/00005650-199209000-00010"},{"key":"e_1_3_3_33_2","doi-asserted-by":"publisher","DOI":"10.2337\/dc07-s212"},{"key":"e_1_3_3_34_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.AOG.0000149158.21586.58"},{"key":"e_1_3_3_35_2","doi-asserted-by":"publisher","DOI":"10.2307\/3350374"},{"key":"e_1_3_3_36_2","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2004.041806"},{"key":"e_1_3_3_37_2","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-139-11-200312020-00009"},{"key":"e_1_3_3_38_2","first-page":"1177","article-title":"Episiotomy use in the United States, 1979\u20131997","volume":"100","author":"Weber AM","year":"2002","unstructured":"Weber AM, , Meyn L. Episiotomy use in the United States, 1979\u20131997. Obstet Gynecol, 2002; 100:1177\u20131182.","journal-title":"Obstet Gynecol"},{"key":"e_1_3_3_39_2","first-page":"55","article-title":"A comparison of capitated and fee-for-service Medicaid reimbursement methods on pregnancy outcomes","volume":"33","author":"Oleske DM","year":"1998","unstructured":"Oleske DM, , Branca ML, , Schmidt JB et al. A comparison of capitated and fee-for-service Medicaid reimbursement methods on pregnancy outcomes. Health Serv Res, 1998; 33:55\u201373.","journal-title":"Health Serv Res"},{"key":"e_1_3_3_40_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.AOG.0000249608.11864.b6"},{"key":"e_1_3_3_41_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1479-828X.2005.00339.x"},{"key":"e_1_3_3_42_2","doi-asserted-by":"publisher","DOI":"10.1177\/1062860606288243"},{"key":"e_1_3_3_43_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2005.08.058"}],"container-title":["Journal of Women's Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1089\/jwh.2008.1114","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1089\/jwh.2008.1114","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1089\/jwh.2008.1114","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T17:30:42Z","timestamp":1777656642000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1089\/jwh.2008.1114"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2009,10]]},"references-count":42,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2009,10]]}},"alternative-id":["10.1089\/jwh.2008.1114"],"URL":"https:\/\/doi.org\/10.1089\/jwh.2008.1114","relation":{},"ISSN":["1540-9996","1931-843X"],"issn-type":[{"value":"1540-9996","type":"print"},{"value":"1931-843X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2009,10]]}}}