Regional Variation in Neonatal Intensive Care Admissions and the Relationship to Bed Supply

Harrison, Wade N; Wasserman, Jared R.; Goodman, David C.

doi:10.1016/j.jpeds.2017.08.028

Cited by 82 publications

(87 citation statements)

References 27 publications

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“…Harrison et al also reported that there the NICU is underused for very low-birth-weight infants and overused for infants >1,500 g, based on NICU bed supply. 26 To date, there are no studies comparing the outcome measures of care provided to late premature infants at Level II versus Level IV NICUs.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Neonatal Services Provided in a Level II NICU Utilizing Hybrid Telemedicine: A Prospective Study

Makkar

McCoy

Hallford

et al. 2020

Telemedicine and e-Health

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Objective: To evaluate the safety and efficacy of premature infant treatment managed by hybrid telemedicine versus conventional care. Methods: Prospective, noninferiority study comparing outcomes of premature infants at Comanche County Memorial Hospital's (CCMH) Level II neonatal intensive care unit (NICU) with outcomes at OU Medical Center's (OUMC) Level IV NICU. All 32-35 weeks gestational age (GA) infants admitted between May 2015 and October 2017 were included. Infants requiring mechanical ventilation >24 h or advanced subspecialty care were excluded. Outcome variables were: length of stay (LOS), respiratory support, and time to full per oral (PO) feeds. Parents at both centers were surveyed about their satisfaction with the care provided. Between-group comparisons were performed by using Chi-square or Fisher's exact test. LOS was assessed for normality by using the Shapiro-Wilk test, and robust regression was used to construct a multivariable regression model to test the independent effect of location on LOS. All analyses were performed by using SAS v. 9.3 (SAS Institute, Cary, NC). Results: Data from 85 CCMH and 70 OUMC neonates were analyzed. CCMH neonates had significantly shorter LOS, reached full PO feeds sooner, and had fewer noninvasive ventilation support days. Location had a significant independent effect (p = 0.001) on LOS while controlling for GA, gender, race, surfactant use, inborn/outborn status, and 5-min APGAR scores. CCMH patients had reduced LOS of 3.01 days (95% confidence interval 1.1-4.8) than OUMC patients. Eighty-five surveys at CCMH and 66 at OUMC were analyzed. Compared with CCMH, OUMC parents reported more travel distance difficulties. 92.5% reported telemedicine experience as good or excellent, whereas 1.5% reported it as poor. Conclusion(s): Hybrid telemedicine is a safe and effective way to extend intensive neonatal care to medically underserved areas. Parental satisfaction with use of hybrid telemedicine is high and comparable to conventional care.

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Section: Discussionmentioning

confidence: 99%

Evaluation of Neonatal Services Provided in a Level II NICU Utilizing Hybrid Telemedicine: A Prospective Study

Makkar

McCoy

Hallford

et al. 2020

Telemedicine and e-Health

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“…Infants are admitted for many nonacute reasons, such as hypoglycemia and rule-out sepsis, and for specific interventions such as antibiotic administration or line placement. 23 More practically, bed supply 24,25 and supply-sensitive care 26 -28 may play roles in admission rates. In recent research, authors have pointed to possible overuse of NICU care, particularly among larger infants.…”

Section: Discussionmentioning

confidence: 99%

“…In recent research, authors have pointed to possible overuse of NICU care, particularly among larger infants. 9,24 Quality improvement approaches can reduce potentially unnecessary NICU admissions, such as those for hypoglycemia, 29 elective delivery before 39 weeks' gestation, 30 neonatal abstinence syndrome, 31 or rule-out sepsis. 32 Not surprisingly, the distribution of days of stay differed within and between NICU types.…”

Section: Discussionmentioning

confidence: 99%

Variation in Use by NICU Types in the United States

Edwards

Horbar

2018

Pediatrics

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BACKGROUND: Increased admissions of higher birth weight and less acutely ill infants to NICUs suggests that intensive care may be used inappropriately in these populations. We describe variation in use of NICU services by gestational age and NICU type. METHODS:Using the Vermont Oxford Network database of all NICU admissions, we assessed variation within predefined gestational age categories in the following proportions: admissions, initial NICU hospitalization days, high-acuity cases ≥34 weeks' gestation, and short-stay cases ≥34 weeks' gestation. High acuity was defined as follows: death, intubated assisted ventilation for ≥4 hours, early bacterial sepsis, major surgery requiring anesthesia, acute transport to another center, hypoxic-ischemic encephalopathy or a 5-minute Apgar score ≤3, or therapeutic hypothermia. Short stay was defined as an inborn infant staying 1 to 3 days with discharge from the hospital. RESULTS:From 2014 to 2016, 486 741 infants were hospitalized 9 657 508 days at 381 NICUs in the United States. The median proportions of admissions, initial hospitalized days, highacuity cases, and short stays varied significantly by NICU types in almost all gestational age categories. Fifteen percent of the infants ≥34 weeks were high acuity, and 10% had short stays. CONCLUSIONS:There is substantial variation in use among NICUs. A campaign to focus neonatal care teams on using the NICU wisely that addresses the appropriate use of intensive care for newborn infants and accounts for local context and the needs of families is needed. abstract a Vermont Oxford Network,

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“…Second, increased supply of care may lead to a situation where those patients whose clinical condition does not require enhanced treatment find this service and start to use the care system more than their clinical status would require. This has been shown to happen in various clinical settings [11][12][13]. We do not know if there is a risk of overuse of T2D care system among previous dropouts.…”

Section: Introductionmentioning

confidence: 96%

Relationship between number of contacts between previous dropouts with type 2 diabetes and health care professionals on glycaemic control: A cohort study in public primary health care

Kauppila

Eriksson

Honkasalo

et al. 2019

Primary Care Diabetes

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Regional Variation in Neonatal Intensive Care Admissions and the Relationship to Bed Supply

Cited by 82 publications

References 27 publications

Evaluation of Neonatal Services Provided in a Level II NICU Utilizing Hybrid Telemedicine: A Prospective Study

Evaluation of Neonatal Services Provided in a Level II NICU Utilizing Hybrid Telemedicine: A Prospective Study

Variation in Use by NICU Types in the United States

Relationship between number of contacts between previous dropouts with type 2 diabetes and health care professionals on glycaemic control: A cohort study in public primary health care

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