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Research study

Admitting Privileges and Hospital-Based Care After Presenting for Abortion in Three States

- back to the Evaluation of Abortion Restrictions Project

Background

Several states have passed laws requiring physicians who provide abortion care to have hospital admitting privileges. Despite a U.S. Supreme Court ruling in 2016 that a Texas admitting privilege law was unconstitutional, many admitting privilege laws continue to be in effect. We explore the pathways by which abortion patients were transferred and referred to hospitals, including emergency departments (EDs), and describe the care patients received at hospitals before and after physicians at abortion facilities obtained privileges.

Objectives

The objectives of this study are:

  1. To explore whether obtaining admitting privileges influenced how patient care was managed between abortion facilities and hospitals. 
  2. To describe the pathways of care when an abortion patient was transferred or referred to an emergency department (ED) or hospital.

Study design

Retrospective chart data on hospital transfer/referrals and care were abstracted from 3 abortion facilities in states where admitting privilege laws passed within the previous 5 years. We included cases that had any contact with a hospital or ED after presenting for an abortion (and that contact was known to the abortion-providing facility) that occurred up to 5 years before and 5 years after abortion-providing physicians obtained admitting privileges.

Key findings

Both before and after admitting privileges, the majority of patients were referred to a hospital before the abortion was attempted and most were for suspected ectopic pregnancy or to perform the abortion in a hospital. Direct ambulance transfer from the facility to the ED/hospital was the least common pathway. We observed few changes in practice from before to after admitting privileges. Preexisting mechanisms of coordination and communication facilitated care that was tailored for the specific patient.

Conclusions

We did not find evidence that physician admitting privileges influenced the pathways through which abortion patients obtain hospital‐based care, as existing mechanisms of collaboration between hospitals and abortion facilities allowed for management of patients who sought hospital‐based care.

The results of this study can be found in, "Admitting privileges and hospital‐based care after presenting for abortion: A retrospective case series," available for free from the journal Health Services Research.

 

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ANSIRH is a program within the UCSF Bixby Center for Global Reproductive Health and is a part of UCSF's Department of Obstetrics, Gynecology & Reproductive Sciences.

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