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The Association of Level of Care With NICU Quality.

CPQCC Publication
TitleThe Association of Level of Care With NICU Quality.
Publication TypeJournal Article
Year of Publication2016
AuthorsProfit J, Gould JB, Bennett M, Goldstein BA, Draper D, Phibbs CS, Lee HC
Date Published2016 Mar
KeywordsCalifornia, Cross-Sectional Studies, Humans, Infant, Newborn, Infant, Very Low Birth Weight, Intensive Care Units, Neonatal, Outcome Assessment (Health Care), Quality Indicators, Health Care

BACKGROUND: 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.

METHODS: 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.

RESULTS: 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, neonatologist coverage, urban or rural location, and hospital teaching status, were significantly associated with Baby-MONITOR scores.

CONCLUSIONS: The comprehensive assessment of the effect of level of care on quality reveals differential opportunities for improvement and allows monitoring of efforts to ensure that fragile VLBW infants receive care in appropriate facilities.

Alternate JournalPediatrics
PubMed ID26908663
PubMed Central IDPMC4771123
Grant ListR01 HD083368 / HD / NICHD NIH HHS / United States
K23HD068400 / HD / NICHD NIH HHS / United States
K23 HD068400 / HD / NICHD NIH HHS / United States
K25 DK097279 / DK / NIDDK NIH HHS / United States
K23 HD056298 / HD / NICHD NIH HHS / United States
1 R01 HD083368-01 / HD / NICHD NIH HHS / United States