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    
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.
C S Phibbs; J M Bronstein; E Buxton; R H Phibbs
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Publication Detail:
Type:  Journal Article; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  JAMA     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:  2014-09-17    
Medline Journal Info:
Nlm Unique ID:  7501160     Medline TA:  JAMA     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1054-9     Citation Subset:  AIM; IM    
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MeSH Terms
California / epidemiology
Health Services Accessibility
Health Services Needs and Demand
Hospitals / statistics & numerical data
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
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

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