Document Detail


The effects of patient volume and level of care at the hospital of birth on neonatal mortality.
MedLine Citation:
PMID:  8847767     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To examine the effects of neonatal intensive care unit (NICU) patient volume and the level of NICU care available at the hospital of birth on neonatal mortality. DESIGN: Birth certificate data linked to infant death certificates and to infant discharge abstracts were used in a logistic regression model to control for differences in each patient's clinical and demographic risks. Hospitals were classified by the level of NICU care available (no NICU: level I; intermediate NICU: level II; expanded intermediate NICU: level II+: tertiary NICU: level III) and by the average patient census in the NICU. SETTING: All nonfederal hospitals in California with maternity services. PATIENTS: All births in nonfederal hospitals in California in 1990 (N=594104), 473209 (singletons only) of which were successfully linked with discharge abstracts. Of these infants, 53229 were classified as likely NICU admissions. MAIN OUTCOME MEASURES: Death within the first 28 days of life, or within the first year of life, if continuously hospitalized. RESULTS: Patient volume and level of NICU care at the hospital of birth both had significant effects on mortality. Compared with hospitals without an NICU, infants born in a hospital with a level III NICU with an average NICU census of at least 15 patients per day had significantly lower risk-adjusted neonatal mortality (odds ratio, 0.62; 95% confidence interval, 0.47-0.82; P=.002). Risk-adjusted neonatal mortality for infants born in smaller level III NICUs, and in level II+ and level II NICUs, regardless of size, was not significantly different from hospitals without an NICU, and was significantly higher than hospitals with large level III NICUS. CONCLUSIONS: Risk-adjusted neonatal mortality was significantly lower for births that occurred in hospitals with large (average census, >15 patients per day) level III NICUs. Despite the differences in outcomes, costs for the birth of infants born at hospitals with large level III NICUs were not more than those for infants born at other hospitals with NICUs. Concentration of high-risk deliveries in urban areas in a smaller number of hospitals that could provide level III NICU care has the potential to decrease neonatal mortality without increasing costs.
Authors:
C S Phibbs; J M Bronstein; E Buxton; R H Phibbs
Related Documents :
3792377 - Obstetrical and neonatal risk factors in very low birth weight infants related to their...
16449257 - Moderately premature infants at kaiser permanente medical care program in california ar...
17653217 - Treating hypotension in the preterm infant: when and with what: a critical and systemat...
1396277 - A 50-year overview of perinatal medicine.
7285657 - The predictive validity of infant assessments in rural guatemala.
11228267 - Reduced arousals following obstructive apneas in infants sleeping prone.
Publication Detail:
Type:  Journal Article; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  JAMA : the journal of the American Medical Association     Volume:  276     ISSN:  0098-7484     ISO Abbreviation:  JAMA     Publication Date:  1996 Oct 
Date Detail:
Created Date:  1996-10-23     Completed Date:  1996-10-23     Revised Date:  2007-11-14    
Medline Journal Info:
Nlm Unique ID:  7501160     Medline TA:  JAMA     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1054-9     Citation Subset:  AIM; IM    
Affiliation:
Health Services Research and Development Center for Health Care Evaluation, VA Medical Center, Menlo Park, CA 94025, USA.
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Descriptor/Qualifier:
California / epidemiology
Health Services Accessibility
Health Services Needs and Demand
Hospitals / statistics & numerical data
Humans
Infant
Infant Mortality*
Infant, Newborn
Intensive Care Units, Neonatal / statistics & numerical data*
Intensive Care, Neonatal*
Logistic Models
Multivariate Analysis
Outcome Assessment (Health Care)*
Patient Admission / statistics & numerical data*
Research Design
Grant Support
ID/Acronym/Agency:
HS-282-0039/HS/AHRQ HHS; HS-290-92-0055/HS/AHRQ HHS

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


Previous Document:  Health care utilization and outcomes among persons with rheumatoid arthritis in fee-for-service and ...
Next Document:  Decline in hospital utilization and cost inflation under managed care in California.