Fitting in? Physician practice style after forced relocation

Objective This study aims to examine how variation in physicians' treatment decisions for newborn deliveries responds to changes in the hospital‐level norms for obstetric clinical decision‐making. Data Sources All hospital‐based births in Florida from 2003 through 2017. Study Design Difference‐...

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Bibliographic Details
Published in:Health services research 2024-08, Vol.59 (4), p.e14340-n/a
Main Authors: Chen, Alice J., Richards, Michael R., Shriver, Rachel
Format: Article
Language:English
Subjects:
Behavior change
Births
Clinical decision making
Closure
Decision making
Decisions
Extraction
Health care management
Health services
Hospitals
Infants
Maternal behavior
Neonates
Newborn babies
newborn deliveries
Norms
obstetric unit closures
Obstetricians
Obstetrics
physician practice patterns
Physicians
Relocation
Shutters
Statistical analysis
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Summary:Objective This study aims to examine how variation in physicians' treatment decisions for newborn deliveries responds to changes in the hospital‐level norms for obstetric clinical decision‐making. Data Sources All hospital‐based births in Florida from 2003 through 2017. Study Design Difference‐in‐differences approach is adopted that leverages obstetric unit closures as the source of identifying variation to exogenously shift obstetricians to a new, nearby hospital with different propensities to approach newborn deliveries less intensively. Data Extraction Births attributed to physicians continuously observed 2 years before the closure event and 2 years after the closure event (treatment group physicians) or for identical time periods around a randomly assigned placebo closure date (control group physicians). Principal Findings All of the physicians meeting our inclusion criteria shifted their births to a new hospital less than 20 miles from the hospital shuttering its obstetric unit. The new hospitals approached newborn births more conservatively, and treatment group physicians sharply became less aggressive in their newborn birth clinical management (e.g., use of C‐section). The immediate 11‐percentage point (33%) increase in delivering newborns without any procedure behavior change is statistically significant (p value
ISSN:0017-9124
1475-6773
1475-6773
DOI:10.1111/1475-6773.14340