Risk-Appropriate Care for High-risk Births: An Evaluation of Process Outcomes of Perinatal Regionalization Systems

Perinatal regionalization is a coordinated system that distributes perinatal services across hospitals within a region according to their level-of-care designation. While guided by a structured framework, its implementation varies widely, raising questions about the effectiveness of current systems in improving maternal and neonatal outcomes in an ever-evolving healthcare field. This thesis aimed to evaluate perinatal regionalization systems and their process outcomes through two studies. The first is a systematic review of global perinatal regionalization systems. Findings revealed that most high-risk births occurred in risk-appropriate facilities, with such deliveries associated with favourable outcomes, including reduced perinatal/neonatal/infant mortality. The second, an exploratory study using Ontario’s 2011–2019 Discharge Abstract Database to examine the distribution of birth hospitals by gestational age, demonstrated that most high-risk births, identified as preterm, occurred in hospitals within the top tertile of delivery volume. Together, these findings provide a comprehensive evaluation of how these systems function within today’s healthcare landscape.