Quality in Primary Care Open Access

A Survey of Patients Who Chose a Municipal Hospital for Their Obstetric Care

Judith L. Chervenak^1*, Wendy Wilcox², Judita Bautista³ and Machelle Allen^{4 1}Department of Obstetrics and Gynecology, NYU Grossman School of Medicine, New York, USA
²Chief Women’s Health Service Officer, New York City Health and Hospitals, New York, USA
³Department of Obstetrics and Gynecology, H+H/Bellevue Hospital Medical Center, NYU Grossman School of Medicine, New York, USA
⁴Chief Medical Officer, New York City Health and Hospitals, New York, USA
^*Correspondence: Judith L. Chervenak, Department of Obstetrics and Gynecology, NYU Grossman School of Medicine, New York, USA, Email:

Received: 19-Dec-2023, Manuscript No. ipqpc-23-18627; Editor assigned: 21-Dec-2023, Pre QC No. ipqpc-23-18627 (PQ); Reviewed: 04-Jan-2024, QC No. ipqpc-23-18627; Revised: 09-Jan-2024, Manuscript No. ipqpc-23-18627 (R); Published: 16-Jan-2024, DOI: 10.36648/1479-1064.31.6.41

Introduction

New York city Health and Hospitals (NYCH+H), the largest municipal hospital system in the country, was responsible for nearly 5% of the 110,442 deliveries in New York City (NYC) in 2019. To determine why patients chose a public safety-net hospital for obstetric care, we surveyed patients at two of them [1].

Methods

An anonymous multiple-choice survey, available in English or Spanish, was offered to patients who presented for obstetric care between April 1 and May 31, 2019 to a municipal hospital in either Manhattan or Brooklyn, 64% and 86.5% of whose patients identify as either black or Hispanic respectively. Respondents chose between ten closed and one open-ended reason and indicated which was primary. Responses of patients in Manhattan were compared to those in Brooklyn using chi-squared and Fischer’s exact test with a p value of <0.05 being considered significant. The study was approved by the institutional review board.

Results

192 patients of approximately 460 patients completed the survey. Respondent characteristics are shown. The most important reason for choosing the hospital overall, 29.6% (n=57), and for choosing the Manhattan hospital, was having been to the hospital before 34.4% (n=37) while proximity to where one lived was the primary reason for choosing the Brooklyn hospital 34.5% (n=29). Comparing patients in Manhattan and Brooklyn, proximity to where they lived (n=29, 20; p<0.5) was more important as both a primary and secondary choice to the Brooklyn patients for whom travel time of less than 30 minutes and being able to walk, use a bus or car was significantly different. Significantly more patients in Manhattan used a train or required two modes of transport. Comfort with language was the only other statistically significant difference when comparing Manhattan to Brooklyn patients as a secondary motivator for Manhattan patients (Tables 1 and 2).

Table 1: Characteristics of respondents

Table 2: Responses to survey: Comparison of responses from Manhattan to Brooklyn patients

Discussion

Our survey found that among a population of patients who chose one of two of our municipal hospitals, the majority did so for many of the same reasons given by women in other studies who sought care in other institutions: Convenience of location, recommendation of friends and family and familiarity with the hospital. Over 60% of our patients were insured, indicating insurance status was not an important factor in their choice of delivery hospital. 56% of patients relied on either their personal experience or the recommendation of a friend or relative [2].

A recent study found large disparities in obstetric care based upon race of the mother as well as the location of and population served by the hospital where these women gave birth [3]. They also determined that site of delivery may contribute to excess morbidity among Hispanic women. Differential location of care is a recognized component of structural racism [4]. When looking at disparities in care within the same hospital based upon insurance status, Howell et al. found that women insured by Medicaid had similar risks as those insured by commercial plans. They suspected that the effects of reduced reimbursement may operate at the hospital level but not at the individual level. Their research also showed that high-medicaid hospitals could be found in the lowest and highest clusters for severe maternal morbidity indicating that acceptance of more Medicaid patients alone did not explain hospital performance with respect to maternal outcomes. It has been shown that “despite great clinical and policy interest, surprisingly few pregnant women use available quality data to choose their obstetric hospital” [5,6].

Limitations of our study are that it was not a structured or validated survey, the 41.7% response rate and its availability in two languages while almost 25% of New Yorkers are not proficient in English and patients seeking care at NYC municipal hospitals speak over 190 languages [7].

Conclusion

In order to effectively reduce maternal morbidity and mortality, we need to listen to those patient populations who are disproportionately served by municipal hospitals and who are at the highest risk. Understanding the patient’s experience, and any barriers to choice, real or perceived, is important to this goal. Future research should focus not only on differences in locations of care but on why patients make choices that have been shown to significantly impact maternal morbidity and mortality.

Acknowledgement

None.

Conflict Of Interest

The author states there is no conflict of interest.

References

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