Indirect vs Direct Hospital Quality Indicators for Very Low-Birth-Weight Infants

Rogowski, Jeannette; Horbar, Jeffrey D.; Staiger, Douglas O.; Kenny, Michael; Carpenter, Joseph A.; Geppert, Jeffrey

doi:10.1001/jama.291.2.202

Cited by 125 publications

(88 citation statements)

References 21 publications

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“…In addition to the association between high hospital level and decreased mortality of VLBWI [4][5][6], high patient volumes have been associated with decreased mortality [4,38] and rate of severe intraventricular haemorrhages (IVH) in VLBWI [39]. As shown in our previous study [5], VLBWI born in level III hospitals had lower 1-year mortality rates than those born in level II hospitals.…”

Section: Discussionmentioning

confidence: 75%

Development and behaviour of 5-year-old very low birthweight infants

Rautava

Andersson

Gissler

et al. 2010

Eur Child Adolesc Psychiatry

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The place and time of birth influence the mortality of premature infants. We studied the effect of prematurity, time of birth, birth hospital level and district on the development and behaviour in a national cohort of 5-year-old Finnish very low birthweight infants (VLBWI). All surviving VLBWI (gestational age \32 weeks or birthweight B1,500 g) born in 2001-2002 in level II or III hospitals in Finland and full-term controls were included. The parents of 588 (64%) VLBWI and 176 (46%) controls returned the Five to Fifteen questionnaire (FTF) on the development and behaviour of their 5-year-old children. The questionnaire scores were linked to data from the National Medical Birth Register, the Hospital Discharge Register, the Register of Congenital Malformations and the Cause of Death Register. VLBWI had lower developmental and behavioural scores compared to the controls in all FTF domains. In VLBWI, the scores were less optimal, the lower the gestational age was. The time of birth, birth hospital level and district were not associated with the developmental and behavioural scores in VLBWI. In conclusion, short duration of pregnancy adversely influences development and behaviour in VLBWI. Despite differences previously demonstrated in mortality related to time and place of birth, there were no differences in developmental and behavioural scores in VLBWI according to the time of birth, birth hospital level or district. Thus, the survival advantage in level III hospitals seems not to be gained at the expense of behavioural or developmental problems.

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Section: Discussionmentioning

confidence: 75%

Development and behaviour of 5-year-old very low birthweight infants

Rautava

Andersson

Gissler

et al. 2010

Eur Child Adolesc Psychiatry

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“…The VON risk-adjustment model using these variables compares well with physiologically based measures such as the Score for Neonatal Acute Physiology (SNAP) score, with an area under the Receiver Operating Characteristic (ROC) curve of 0.89 in these data. 15 n Sample size. By 2000 the VON database included approximately half of all very-low-birthweight infants born in the United States and 40 percent of NICUs.…”

Section: Study Data and Methodsmentioning

confidence: 99%

“…The level of the NICU and location in a large metropolitan area were the only other hospital-level factors that were significantly associated with mortality, but they explained at most an additional 7 percent of the variation. 25 In other words, the systematic differences in mortality across hospitals are large relative to the differences that can be predicted by readily observable hospital characteristics.…”

Section: Evidence-based Selective Referralmentioning

confidence: 99%

Variations In The Quality Of Care For Very-Low-Birthweight Infants: Implications For Policy

Rogowski¹,

Staiger²,

Horbar

2004

Health Affairs

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Much of the decline in childhood mortality over the past two decades is attributable to improvements in neonatal intensive care for very-low-birthweight infants. Yet large and persistent disparities persist in the quality of neonatal intensive care across hospitals. Improving care for infants now served by hospitals with poor outcomes can greatly reduce infant mortality, particularly among minority infants who are more likely to be very low birthweight and cared for by hospitals with poor outcomes. Referral of high-risk births to hospitals with the best outcomes is another promising strategy. T h e u n i t e d s tat e s h a s o n e o f t h e h i g h e s t infant mortality rates among industrialized countries. This is particularly true among blackAmerican infants, whose mortality rates are 2.5 times those of white American infants. More than two-thirds of all deaths among Americans under age fifteen occur in the first year of life, and nearly half occur within twenty-eight days of birth.1 Deaths are concentrated among infants with low birthweight (less than 2,500 grams at birth) and especially very low birthweight (less than 1,500 grams at birth). Low-birthweight infants constitute 7.6 percent of all U.S. births but account for nearly two-thirds of all infant deaths, while very-low-birthweight infants constitute 1.4 percent of all U.S. births but account for more than half of infant deaths.2 Thus, more than one-third of all deaths among children under age fifteen occur in the first year of life among infants with very low birthweight.Because of this, there has been great policy interest in reducing U.S. infant mortality rates. Efforts to reduce the proportion of low-birthweight and very-lowbirthweight infants, however, have been largely ineffective. Medical interventions to identify women at risk and to reduce the rates of preterm birth have not been

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“…Weiterhin ist die in der neonatologischen wissenschaftlichen Gemeinde sehr heftig und emotional diskutierte Frage von Mindestmengen in diesem Kontext zu erw ä hnen. W ä hrend in der ersten H ä lfte des laufenden Jahrzehnts Daten aus den USA einen deutlichen Zusammenhang zwischen der Ü berlebensprognose sehr kleiner Fr ü hgeborener, d. h. Kindern eines Geburtsgewichtes von < 1 500 g mit einem " Schwellenwert " von 50 Aufnahmen entsprechender Fr ü hgeborener, belegen [9] , gehen aktuelle Zahlen aus der Bundesrepublik Deutschland von einem Schwellenwert der Mindestmengen in der Gr ö ß enordnung von 36 Kindern oder mehr dieser Gewichtsklasse aus zur Optimierung der Behandlungsresultate [1] . Weitere hier nicht zitierte Arbeiten belegen einen Zusammenhang von Aufnahmezahlen sehr kleiner Fr ü hgeborener und den Behandlungsresultaten, wenngleich dieser Zusammenhang nicht identisch reproduzierbar und der statistische Zusammenhang schw ä cher als erwartet ist [8] .…”

Section: Structure Of Perinatal and Neonatal Care -Impact For Outcomeunclassified

Versorgungsstruktur in der Geburtsmedizin und Neonatologie – Implikationen für die Behandlungsergebnisse?

Gortner¹

2009

Klin Padiatr

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Indirect vs Direct Hospital Quality Indicators for Very Low-Birth-Weight Infants

Cited by 125 publications

References 21 publications

Development and behaviour of 5-year-old very low birthweight infants

Development and behaviour of 5-year-old very low birthweight infants

Variations In The Quality Of Care For Very-Low-Birthweight Infants: Implications For Policy

Versorgungsstruktur in der Geburtsmedizin und Neonatologie – Implikationen für die Behandlungsergebnisse?

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