The Effect of Neonatal Intensive Care Level and Hospital Volume on Mortality of Very Low Birth Weight Infants
Objective: To determine the adjusted effect of hospital level of care and volume on mortality of very low birth weight (VLBW) infants in the state of California, where deregionalization of perinatal care has occurred. Research Design: Secondary data analysis of California maternal-infant hospital di...
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| Veröffentlicht in: | Medical care 2010-07, Vol.48 (7), p.635-644 |
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| creator | Chung, Judith H. Phibbs, Ciaran S. Boscardin, W. John Kominski, Gerald F. Ortega, Alexander N. Needleman, Jack |
| description | Objective: To determine the adjusted effect of hospital level of care and volume on mortality of very low birth weight (VLBW) infants in the state of California, where deregionalization of perinatal care has occurred. Research Design: Secondary data analysis of California maternal-infant hospital discharge data from 1997 to 2002 was performed. Logistic regression was used to evaluate the odds of mortality among VLBW infants by hospital level of neonatal intensive care and volume of VLBW deliveries, in the context of differences in antenatal and delivery factors by hospital site of delivery. Results: Both maternal and fetal antenatal risk profiles and delivery characteristics vary by hospital site of delivery. After risk adjustment, lower-level, lower-volume units were associated with a higher odds of mortality. The highest odds of mortality occurred in level-1 units with ≤10 VLBW deliveries per year (odds ratio, 1.69; 95% confidence interval, 1.43-1.99). In isolation, hospital volume, rather than level of care, had the greater effect. Conclusions: Although deregionalization of perinatal services may increase access to care for high-risk mothers and newborns, its impact on hospital volume may outweigh its potential benefit. |
| doi_str_mv | 10.1097/MLR.0b013e3181dbe887 |
| format | Article |
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John ; Kominski, Gerald F. ; Ortega, Alexander N. ; Needleman, Jack</creator><creatorcontrib>Chung, Judith H. ; Phibbs, Ciaran S. ; Boscardin, W. John ; Kominski, Gerald F. ; Ortega, Alexander N. ; Needleman, Jack</creatorcontrib><description>Objective: To determine the adjusted effect of hospital level of care and volume on mortality of very low birth weight (VLBW) infants in the state of California, where deregionalization of perinatal care has occurred. Research Design: Secondary data analysis of California maternal-infant hospital discharge data from 1997 to 2002 was performed. Logistic regression was used to evaluate the odds of mortality among VLBW infants by hospital level of neonatal intensive care and volume of VLBW deliveries, in the context of differences in antenatal and delivery factors by hospital site of delivery. Results: Both maternal and fetal antenatal risk profiles and delivery characteristics vary by hospital site of delivery. After risk adjustment, lower-level, lower-volume units were associated with a higher odds of mortality. The highest odds of mortality occurred in level-1 units with ≤10 VLBW deliveries per year (odds ratio, 1.69; 95% confidence interval, 1.43-1.99). In isolation, hospital volume, rather than level of care, had the greater effect. Conclusions: Although deregionalization of perinatal services may increase access to care for high-risk mothers and newborns, its impact on hospital volume may outweigh its potential benefit.</description><identifier>ISSN: 0025-7079</identifier><identifier>EISSN: 1537-1948</identifier><identifier>DOI: 10.1097/MLR.0b013e3181dbe887</identifier><identifier>PMID: 20548252</identifier><identifier>CODEN: MELAAD</identifier><language>eng</language><publisher>United States: Lippincott Williams & Wilkins</publisher><subject>Adult ; Birth weight ; California ; Chi-Square Distribution ; Death ; Female ; Health care delivery ; Health outcomes ; Hospital admissions ; Hospital Bed Capacity - standards ; Hospital Bed Capacity - statistics & numerical data ; Hospital units ; Hospitals ; Hospitals, Pediatric - standards ; Hospitals, Pediatric - statistics & numerical data ; Humans ; Infant Mortality ; Infant, Newborn ; Infant, Very Low Birth Weight ; Infants ; Intensive care ; Intensive Care Units, Neonatal - standards ; Intensive Care Units, Neonatal - statistics & numerical data ; Logistic Models ; Low birth weight ; Maternal Age ; Mortality ; Neonatal care ; Neonatal intensive care ; Neonatal mortality ; Odds Ratio ; Quality of care ; Regression analysis</subject><ispartof>Medical care, 2010-07, Vol.48 (7), p.635-644</ispartof><rights>Copyright © 2010 Lippincott Williams & Wilkins</rights><rights>2010 Lippincott Williams & Wilkins, Inc.</rights><rights>Copyright Lippincott Williams & Wilkins Jul 2010</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4707-ab2d26ed853eb9739e4f009e997c476442fde7789a6499e8e4b82f31f13c7cd93</citedby><cites>FETCH-LOGICAL-c4707-ab2d26ed853eb9739e4f009e997c476442fde7789a6499e8e4b82f31f13c7cd93</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.jstor.org/stable/pdf/25701512$$EPDF$$P50$$Gjstor$$H</linktopdf><linktohtml>$$Uhttps://www.jstor.org/stable/25701512$$EHTML$$P50$$Gjstor$$H</linktohtml><link.rule.ids>314,776,780,799,27901,27902,57992,58225</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/20548252$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Chung, Judith H.</creatorcontrib><creatorcontrib>Phibbs, Ciaran S.</creatorcontrib><creatorcontrib>Boscardin, W. John</creatorcontrib><creatorcontrib>Kominski, Gerald F.</creatorcontrib><creatorcontrib>Ortega, Alexander N.</creatorcontrib><creatorcontrib>Needleman, Jack</creatorcontrib><title>The Effect of Neonatal Intensive Care Level and Hospital Volume on Mortality of Very Low Birth Weight Infants</title><title>Medical care</title><addtitle>Med Care</addtitle><description>Objective: To determine the adjusted effect of hospital level of care and volume on mortality of very low birth weight (VLBW) infants in the state of California, where deregionalization of perinatal care has occurred. Research Design: Secondary data analysis of California maternal-infant hospital discharge data from 1997 to 2002 was performed. Logistic regression was used to evaluate the odds of mortality among VLBW infants by hospital level of neonatal intensive care and volume of VLBW deliveries, in the context of differences in antenatal and delivery factors by hospital site of delivery. Results: Both maternal and fetal antenatal risk profiles and delivery characteristics vary by hospital site of delivery. After risk adjustment, lower-level, lower-volume units were associated with a higher odds of mortality. The highest odds of mortality occurred in level-1 units with ≤10 VLBW deliveries per year (odds ratio, 1.69; 95% confidence interval, 1.43-1.99). In isolation, hospital volume, rather than level of care, had the greater effect. Conclusions: Although deregionalization of perinatal services may increase access to care for high-risk mothers and newborns, its impact on hospital volume may outweigh its potential benefit.</description><subject>Adult</subject><subject>Birth weight</subject><subject>California</subject><subject>Chi-Square Distribution</subject><subject>Death</subject><subject>Female</subject><subject>Health care delivery</subject><subject>Health outcomes</subject><subject>Hospital admissions</subject><subject>Hospital Bed Capacity - standards</subject><subject>Hospital Bed Capacity - statistics & numerical data</subject><subject>Hospital units</subject><subject>Hospitals</subject><subject>Hospitals, Pediatric - standards</subject><subject>Hospitals, Pediatric - statistics & numerical data</subject><subject>Humans</subject><subject>Infant Mortality</subject><subject>Infant, Newborn</subject><subject>Infant, Very Low Birth Weight</subject><subject>Infants</subject><subject>Intensive care</subject><subject>Intensive Care Units, Neonatal - standards</subject><subject>Intensive Care Units, Neonatal - statistics & numerical data</subject><subject>Logistic Models</subject><subject>Low birth weight</subject><subject>Maternal Age</subject><subject>Mortality</subject><subject>Neonatal care</subject><subject>Neonatal intensive care</subject><subject>Neonatal mortality</subject><subject>Odds Ratio</subject><subject>Quality of care</subject><subject>Regression analysis</subject><issn>0025-7079</issn><issn>1537-1948</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2010</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkc1u1DAURi0EosPAGwCyumGV1n8Z20sYtbRSWiRUyjJykmuSwYkH2-lo3h6PpoDUDQvrStb5jq7uh9BbSs4o0fL8pvp6RhpCOXCqaNeAUvIZWtCSy4JqoZ6jBSGsLCSR-gS9inFDCJW8ZC_RCSOlUKxkCzTe9YAvrIU2YW_xLfjJJOPw9ZRgisMD4LUJgCt4AIfN1OErH7fDgbj3bh4B-wnf-JA_hrQ_GO4h7HHld_jTEFKPv8Pwo09ZZ82U4mv0whoX4c3jXKJvlxd366ui-vL5ev2xKlqR1y1Mwzq2gk6VHBotuQZhCdGgtczASghmO5BSabMSWoMC0ShmObWUt7LtNF-iD0fvNvhfM8RUj0NswTkzgZ9jLTnn-eXjLdHpE3Lj5zDl5epSSqYFWZEMiSPUBh9jAFtvwzCasK8pqQ9l1LmM-mkZOfb-0T03I3R_Q3-unwF1BHbeJQjxp5t3EOoejEv9_9zvjtFNTD78U5eS0JIy_hu82qFf</recordid><startdate>20100701</startdate><enddate>20100701</enddate><creator>Chung, Judith H.</creator><creator>Phibbs, Ciaran S.</creator><creator>Boscardin, W. John</creator><creator>Kominski, Gerald F.</creator><creator>Ortega, Alexander N.</creator><creator>Needleman, Jack</creator><general>Lippincott Williams & Wilkins</general><general>Lippincott Williams & Wilkins, Inc</general><general>Lippincott Williams & Wilkins Ovid Technologies</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>K9.</scope><scope>7X8</scope></search><sort><creationdate>20100701</creationdate><title>The Effect of Neonatal Intensive Care Level and Hospital Volume on Mortality of Very Low Birth Weight Infants</title><author>Chung, Judith H. ; Phibbs, Ciaran S. ; Boscardin, W. John ; Kominski, Gerald F. ; Ortega, Alexander N. ; Needleman, Jack</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4707-ab2d26ed853eb9739e4f009e997c476442fde7789a6499e8e4b82f31f13c7cd93</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2010</creationdate><topic>Adult</topic><topic>Birth weight</topic><topic>California</topic><topic>Chi-Square Distribution</topic><topic>Death</topic><topic>Female</topic><topic>Health care delivery</topic><topic>Health outcomes</topic><topic>Hospital admissions</topic><topic>Hospital Bed Capacity - standards</topic><topic>Hospital Bed Capacity - statistics & numerical data</topic><topic>Hospital units</topic><topic>Hospitals</topic><topic>Hospitals, Pediatric - standards</topic><topic>Hospitals, Pediatric - statistics & numerical data</topic><topic>Humans</topic><topic>Infant Mortality</topic><topic>Infant, Newborn</topic><topic>Infant, Very Low Birth Weight</topic><topic>Infants</topic><topic>Intensive care</topic><topic>Intensive Care Units, Neonatal - standards</topic><topic>Intensive Care Units, Neonatal - statistics & numerical data</topic><topic>Logistic Models</topic><topic>Low birth weight</topic><topic>Maternal Age</topic><topic>Mortality</topic><topic>Neonatal care</topic><topic>Neonatal intensive care</topic><topic>Neonatal mortality</topic><topic>Odds Ratio</topic><topic>Quality of care</topic><topic>Regression analysis</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Chung, Judith H.</creatorcontrib><creatorcontrib>Phibbs, Ciaran S.</creatorcontrib><creatorcontrib>Boscardin, W. John</creatorcontrib><creatorcontrib>Kominski, Gerald F.</creatorcontrib><creatorcontrib>Ortega, Alexander N.</creatorcontrib><creatorcontrib>Needleman, Jack</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>Medical care</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Chung, Judith H.</au><au>Phibbs, Ciaran S.</au><au>Boscardin, W. John</au><au>Kominski, Gerald F.</au><au>Ortega, Alexander N.</au><au>Needleman, Jack</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The Effect of Neonatal Intensive Care Level and Hospital Volume on Mortality of Very Low Birth Weight Infants</atitle><jtitle>Medical care</jtitle><addtitle>Med Care</addtitle><date>2010-07-01</date><risdate>2010</risdate><volume>48</volume><issue>7</issue><spage>635</spage><epage>644</epage><pages>635-644</pages><issn>0025-7079</issn><eissn>1537-1948</eissn><coden>MELAAD</coden><abstract>Objective: To determine the adjusted effect of hospital level of care and volume on mortality of very low birth weight (VLBW) infants in the state of California, where deregionalization of perinatal care has occurred. Research Design: Secondary data analysis of California maternal-infant hospital discharge data from 1997 to 2002 was performed. Logistic regression was used to evaluate the odds of mortality among VLBW infants by hospital level of neonatal intensive care and volume of VLBW deliveries, in the context of differences in antenatal and delivery factors by hospital site of delivery. Results: Both maternal and fetal antenatal risk profiles and delivery characteristics vary by hospital site of delivery. After risk adjustment, lower-level, lower-volume units were associated with a higher odds of mortality. The highest odds of mortality occurred in level-1 units with ≤10 VLBW deliveries per year (odds ratio, 1.69; 95% confidence interval, 1.43-1.99). In isolation, hospital volume, rather than level of care, had the greater effect. 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| subjects | Adult Birth weight California Chi-Square Distribution Death Female Health care delivery Health outcomes Hospital admissions Hospital Bed Capacity - standards Hospital Bed Capacity - statistics & numerical data Hospital units Hospitals Hospitals, Pediatric - standards Hospitals, Pediatric - statistics & numerical data Humans Infant Mortality Infant, Newborn Infant, Very Low Birth Weight Infants Intensive care Intensive Care Units, Neonatal - standards Intensive Care Units, Neonatal - statistics & numerical data Logistic Models Low birth weight Maternal Age Mortality Neonatal care Neonatal intensive care Neonatal mortality Odds Ratio Quality of care Regression analysis |
| title | The Effect of Neonatal Intensive Care Level and Hospital Volume on Mortality of Very Low Birth Weight Infants |
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