A systems approach for enhancing perinatal care regionalization

Canadians benefit from an excellent perinatal health care system. However, some problems persist as evidenced by disparities in illness and death among mothers and babies, and unfavourable international comparisons. Thus, rates of serious illness/death among mothers and babies vary significantly by region, socio-economic status, rural vs urban residence, Aboriginal status and other factors. The single biggest challenge confronting the perinatal health care system in Canada relates to regionalization of perinatal care i.e., receipt of the appropriate level of care based on the risks faced by the mother/baby. This problem is highlighted by maternity services in rural regions of Canada - the closure of small hospitals has resulted in the need for low-risk pregnant women to travel long distances for childbirth. Problems also exist in high volume/intensity regions such as the Greater Toronto Area where inadequate tertiary capacity dictates that high-risk women deliver in non-tertiary settings. Other challenges include those due to geography, climate, emergency transport, organizational issues, and the absence of evaluation and monitoring of regionalization. We propose to use a systems approach for evaluating the structure, processes and outcomes of regionalized perinatal care. Such a critical analysis will assess perinatal care regionalization in terms of hospital services, care provision in rural and remote communities and emergency transport. We will also use mapping of travel times from maternal residence to hospital and other novel techniques to rationalize the delivery of maternity/newborn care services. The results of this critical analysis will be used to formulate recommendations in collaboration with provincial/territorial Perinatal Care Programs and Ministries of Health. Implementation of recommendations will also be a carried out in close collaboration with provincial/territorial stakeholders.