The Association of Level of Care With NICU Quality

Pediatrics
J ProfitH C Lee

Abstract

Regionalized care delivery purportedly optimizes care to vulnerable very low birth weight (VLBW; <1500 g) infants. However, a comprehensive assessment of quality of care delivery across different levels of NICUs has not been done. We conducted a cross-sectional analysis of 21,051 VLBW infants in 134 California NICUs. NICUs designated their level of care according to 2012 American Academy of Pediatrics guidelines. We assessed quality of care delivery via the Baby-MONITOR, a composite indicator, which combines 9 risk-adjusted measures of quality. Baby-MONITOR scores are measured as observed minus expected performance, expressed in standard units with a mean of 0 and an SD of 1. Wide variation in Baby-MONITOR scores exists across California (mean [SD] 0.18 (1.14), range -2.26 to 3.39). However, level of care was not associated with overall quality scores. Subcomponent analysis revealed trends for higher performance of Level IV NICUs on several process measures, including antenatal steroids and any human milk feeding at discharge, but lower scores for several outcomes including any health care associated infection, pneumothorax, and growth velocity. No other health system or organizational factors including hospital ownership, neon...Continue Reading

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Citations

Feb 17, 2017·Journal of Perinatology : Official Journal of the California Perinatal Association·J W KaempfN Tipping
Mar 24, 2017·Journal of Perinatology : Official Journal of the California Perinatal Association·S N KunzJ Profit
May 27, 2017·Health Services Management Research : an Official Journal of the Association of University Programs in Health Administration·Simone Fanelli, Antonello Zangrandi
Mar 30, 2018·Journal of Perinatology : Official Journal of the California Perinatal Association·Ravi DhurjatiJochen Profit
Jan 27, 2018·Journal of Perinatology : Official Journal of the California Perinatal Association·Felix MiedanerBernhard Roth
Jan 5, 2018·Archives of Disease in Childhood. Fetal and Neonatal Edition·Joseph W KaempfMichael Dunn
Dec 24, 2019·Health Services Research·Daniel S TawfikCiaran S Phibbs
Jul 16, 2019·Advances in Neonatal Care : Official Journal of the National Association of Neonatal Nurses·Barbara Snapp, Barbara Reyna
Dec 7, 2017·Journal of Perinatology : Official Journal of the California Perinatal Association·Charlan D KroelingerWanda D Barfield
Mar 12, 2020·Journal of Perinatology : Official Journal of the California Perinatal Association·Amy M PadulaJochen Profit
May 11, 2018·Journal of Perinatology : Official Journal of the California Perinatal Association·David AboudiHeather L Brumberg
Dec 30, 2020·American Journal of Perinatology·Devlynne S OnduskoEmily H Carter
Apr 21, 2021·American Journal of Perinatology·Stephanie L BourqueSunah S Hwang
May 27, 2021·Journal of Perinatology : Official Journal of the California Perinatal Association·Sarah N KunzJochen Profit
Aug 1, 2021·Neonatal Network : NN·Ching Ching TayJames Fritzell
Aug 30, 2017·Pediatrics·Jochen ProfitHenry C Lee
Jul 25, 2021·Pediatrics·Erika M EdwardsJeffrey D Horbar

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