{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T22:00:24Z","timestamp":1792101624129,"version":"4.4.0"},"reference-count":45,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2014,2,1]],"date-time":"2014-02-01T00:00:00Z","timestamp":1391212800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"name":"Rural Health Research Center Grant Program Cooperative Agreement from the Health Resources and Services Administration","award":["U1CRH03717-09-00"],"award-info":[{"award-number":["U1CRH03717-09-00"]}]},{"name":"Building Interdisciplinary Research Careers in Women's Health","award":["K12HD055887"],"award-info":[{"award-number":["K12HD055887"]}]},{"name":"National Institutes of Child Health and Human Development"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["The Journal of Rural Health"],"published-print":{"date-parts":[[2014,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Childbirth is the most common reason for hospitalization in the United States. Assessing obstetric care quality is critically important for patients, clinicians, and hospitals in rural areas.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The study used hospital discharge data from the Statewide Inpatient Databases, Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality, for 9 states (Colorado, Iowa, Kentucky, New York, North Carolina, Oregon, Vermont, Washington, and Wisconsin) to identify all births in rural hospitals with 10 or more births\/year in 2002 (N = 94,356) and 2010 (N = 103,880). Multivariate logistic regression was used to assess the relationship between hospital annual birth volume, measured as low (10\u2010110), medium (111\u2010240), medium\u2010high (241\u2010460) or high (&gt;460), and 3 measures of obstetric care quality (low\u2010risk cesarean rates for term, vertex, and singleton pregnancies with no prior cesarean; nonindicated cesarean; and nonindicated induction) and 2 patient safety measures (episiotomy and perineal laceration).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The odds of low\u2010risk and nonindicated cesarean were lower in medium\u2010high and high\u2010volume rural hospitals compared with low\u2010volume hospitals after controlling for maternal demographic and clinical factors. In low\u2010volume hospitals, odds of labor induction without medical indication were higher than in medium\u2010volume hospitals, but not significantly different from medium\u2010high or high\u2010volume hospitals. Odds of episiotomy were greater in medium\u2010high or high\u2010volume hospitals than in low\u2010volume hospitals. The likelihood of perineal laceration did not differ significantly by birth volume.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Obstetric quality and safety outcomes vary significantly across rural hospitals by birth volume. Better performance is not consistently associated with either lower or higher volume facilities.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jrh.12061","type":"journal-article","created":{"date-parts":[[2014,2,1]],"date-time":"2014-02-01T05:54:03Z","timestamp":1391234043000},"page":"335-343","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":33,"title":["Birth Volume and the Quality of Obstetric Care in Rural Hospitals"],"prefix":"10.1111","volume":"30","author":[{"given":"Katy B.","family":"Kozhimannil","sequence":"first","affiliation":[{"name":"Division of Health Policy and Management University of Minnesota School of Public Health  Minneapolis Minnesota"},{"name":"University of Minnesota Rural Health Research Center  Minneapolis Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peiyin","family":"Hung","sequence":"additional","affiliation":[{"name":"Division of Health Policy and Management University of Minnesota School of Public Health  Minneapolis Minnesota"},{"name":"University of Minnesota Rural Health Research Center  Minneapolis Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shailendra","family":"Prasad","sequence":"additional","affiliation":[{"name":"University of Minnesota Rural Health Research Center  Minneapolis Minnesota"},{"name":"Department of Family Medicine and Community Health University of Minnesota Medical School  Minneapolis Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michelle","family":"Casey","sequence":"additional","affiliation":[{"name":"Division of Health Policy and Management University of Minnesota School of Public Health  Minneapolis Minnesota"},{"name":"University of Minnesota Rural Health Research Center  Minneapolis Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maeve","family":"McClellan","sequence":"additional","affiliation":[{"name":"Division of Health Policy and Management University of Minnesota School of Public Health  Minneapolis Minnesota"},{"name":"University of Minnesota Rural Health Research Center  Minneapolis Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ira S.","family":"Moscovice","sequence":"additional","affiliation":[{"name":"Division of Health Policy and Management University of Minnesota School of Public Health  Minneapolis Minnesota"},{"name":"University of Minnesota Rural Health Research Center  Minneapolis Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2014,2]]},"reference":[{"key":"e_1_2_7_2_1","unstructured":"PodulkaJ StrangesE SteinerC.Statistical brief #110: hospitalizations related to childbirth 2008. 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