How far is too far? A nationwide cross-sectional study for establishing optimal hospital access time for Korean pregnant women
Objectives Access to a delivery unit is a major factor in determining maternal morbidity and mortality. However, there is little information about the optimal access time to a delivery unit. This study aimed to establish the optimal hospital access time (OHAT) for pregnant women in South Korea.Desig...
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BMJ Publishing Group
2019-09-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/9/9/e031882.full |
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| author | Mi Young Kwak Seung Mi Lee Hyun Joo Kim Sang Jun Eun Won Mo Jang Hyemin Jung Yoon Kim Jin Yong Lee |
| author_facet | Mi Young Kwak Seung Mi Lee Hyun Joo Kim Sang Jun Eun Won Mo Jang Hyemin Jung Yoon Kim Jin Yong Lee |
| author_sort | Mi Young Kwak |
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| description | Objectives Access to a delivery unit is a major factor in determining maternal morbidity and mortality. However, there is little information about the optimal access time to a delivery unit. This study aimed to establish the optimal hospital access time (OHAT) for pregnant women in South Korea.Design Nationwide cross-sectional study.Setting We used the National Health Insurance System database of South Korea.Participants We analysed the data of 371 341 women who had experienced pregnancy in 2013.Primary and secondary outcome measures Access time to hospital was defined as the time required to travel from the patient’s home to the delivery unit. The incidence of obstetric complications was plotted against the access time to hospital. Change-point analysis was performed to identify the OHAT by determining a point wherein the incidence of obstetric complications changed significantly. As a final step, the risk of obstetric complications was compared by type among pregnant women who lived within the OHAT against those who lived outside the OHAT.Results The OHAT associated with each adverse pregnancy outcomes were as follows: inadequate prenatal care, 41–50 min; preeclampsia, 51–60 min; placental abruption, 51–60 min; preterm delivery, 31–40 min; postpartum transfusion, 31–40 min; uterine artery embolisation, 31–40 min; admission to intensive care unit, 31–40 min; and caesarean hysterectomy, 31–40 min. Pregnant women who lived outside the OHAT had significantly higher risk for obstetric complications than those who lived within the OHAT.Conclusions Our results showed that the OHAT for each obstetric complication ranged between 31 and 60 min. The Korean government should take the OHAT under consideration when establishing interventions for pregnant women who live outside OHAT to reduce maternal morbidity and mortality. |
| format | Article |
| id | doaj-art-6e67d21579034bc2be61d96321dc8a1b |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2019-09-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-6e67d21579034bc2be61d96321dc8a1b2024-11-22T22:45:07ZengBMJ Publishing GroupBMJ Open2044-60552019-09-019910.1136/bmjopen-2019-031882How far is too far? A nationwide cross-sectional study for establishing optimal hospital access time for Korean pregnant womenMi Young Kwak0Seung Mi Lee1Hyun Joo Kim2Sang Jun Eun3Won Mo Jang4Hyemin Jung5Yoon Kim6Jin Yong Lee71 Center for Public Health, National Medical Center, Seoul, South Korea2 Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, South KoreaDepartment of Medicine, Division of Pulmonary, Allergy, Critical Care, and Sleep, University of Minnesota, Minneapolis, Minnesota, USA4 Department of Preventive Medicine, Chungnam National University College of Medicine, Daejeon, South Korea5 Health Review and Assessment Committee, Health Insurance Review & Assessment Service, Wonju, South Korea6 Deaprtment of Health Policy and Management, Seoul National University College of Medicine, Seoul, South Korea6 Deaprtment of Health Policy and Management, Seoul National University College of Medicine, Seoul, South Korea6 Deaprtment of Health Policy and Management, Seoul National University College of Medicine, Seoul, South KoreaObjectives Access to a delivery unit is a major factor in determining maternal morbidity and mortality. However, there is little information about the optimal access time to a delivery unit. This study aimed to establish the optimal hospital access time (OHAT) for pregnant women in South Korea.Design Nationwide cross-sectional study.Setting We used the National Health Insurance System database of South Korea.Participants We analysed the data of 371 341 women who had experienced pregnancy in 2013.Primary and secondary outcome measures Access time to hospital was defined as the time required to travel from the patient’s home to the delivery unit. The incidence of obstetric complications was plotted against the access time to hospital. Change-point analysis was performed to identify the OHAT by determining a point wherein the incidence of obstetric complications changed significantly. As a final step, the risk of obstetric complications was compared by type among pregnant women who lived within the OHAT against those who lived outside the OHAT.Results The OHAT associated with each adverse pregnancy outcomes were as follows: inadequate prenatal care, 41–50 min; preeclampsia, 51–60 min; placental abruption, 51–60 min; preterm delivery, 31–40 min; postpartum transfusion, 31–40 min; uterine artery embolisation, 31–40 min; admission to intensive care unit, 31–40 min; and caesarean hysterectomy, 31–40 min. Pregnant women who lived outside the OHAT had significantly higher risk for obstetric complications than those who lived within the OHAT.Conclusions Our results showed that the OHAT for each obstetric complication ranged between 31 and 60 min. The Korean government should take the OHAT under consideration when establishing interventions for pregnant women who live outside OHAT to reduce maternal morbidity and mortality.https://bmjopen.bmj.com/content/9/9/e031882.full |
| spellingShingle | Mi Young Kwak Seung Mi Lee Hyun Joo Kim Sang Jun Eun Won Mo Jang Hyemin Jung Yoon Kim Jin Yong Lee How far is too far? A nationwide cross-sectional study for establishing optimal hospital access time for Korean pregnant women BMJ Open |
| title | How far is too far? A nationwide cross-sectional study for establishing optimal hospital access time for Korean pregnant women |
| title_full | How far is too far? A nationwide cross-sectional study for establishing optimal hospital access time for Korean pregnant women |
| title_fullStr | How far is too far? A nationwide cross-sectional study for establishing optimal hospital access time for Korean pregnant women |
| title_full_unstemmed | How far is too far? A nationwide cross-sectional study for establishing optimal hospital access time for Korean pregnant women |
| title_short | How far is too far? A nationwide cross-sectional study for establishing optimal hospital access time for Korean pregnant women |
| title_sort | how far is too far a nationwide cross sectional study for establishing optimal hospital access time for korean pregnant women |
| url | https://bmjopen.bmj.com/content/9/9/e031882.full |
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