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Regional variation in antenatal corticosteroid use: a network-level quality improvement study.

CPQCC Publication
TitleRegional variation in antenatal corticosteroid use: a network-level quality improvement study.
Publication TypeJournal Article
Year of Publication2015
AuthorsProfit J, Goldstein BA, Tamaresis J, Kan P, Lee HC
Date Published2015 Feb
KeywordsAdrenal Cortex Hormones, Adult, California, Drug Utilization, Female, Humans, Infant, Newborn, Infant, Very Low Birth Weight, Intensive Care Units, Neonatal, Male, Maternal Age, Pregnancy, Prenatal Exposure Delayed Effects, Quality Assurance, Health Care, Quality Improvement, Regional Medical Programs, Respiratory Distress Syndrome, Newborn, Risk Factors, Topography, Medical, Young Adult

BACKGROUND AND OBJECTIVES: Examination of regional care patterns in antenatal corticosteroid use (ACU) rates may be salient for the development of targeted interventions. Our objective was to assess network-level variation using California perinatal care regions as a proxy. We hypothesized that (1) significant variation in ACU exists within and between California perinatal care regions, and (2) lower performing regions exhibit greater NICU-level variability in ACU than higher performing regions.

METHODS: We undertook cross-sectional analysis of 33,610 very low birth weight infants cared for at 120 hospitals in 11 California perinatal care regions from 2005 to 2011. We computed risk-adjusted median ACU rates and interquartile ranges (IQR) for each perinatal care region. The degree of variation was assessed using hierarchical multivariate regression analysis with NICU as a random effect and region as a fixed effect.

RESULTS: From 2005 to 2011, mean ACU rates across California increased from 82% to 87.9%. Regional median (IQR) ACU rates ranged from 68.4% (24.3) to 92.9% (4.8). We found significant variation in ACU rates among regions (P < .0001). Compared with Level IV NICUs, care in a lower level of care was a strongly significant predictor of lower odds of receiving antenatal corticosteroids in a multilevel model (Level III, 0.65 [0.45-0.95]; Level II, 0.39 [0.24-0.64]; P < .001). Regions with lower performance in ACU exhibited greater variability in performance.

CONCLUSIONS: We found significant variation in ACU rates among California perinatal regions. Regional quality improvement approaches may offer a new avenue to spread best practice.

Alternate JournalPediatrics
PubMed ID25601974
PubMed Central IDPMC4306799
Grant ListK23 HD068400 / HD / NICHD NIH HHS / United States
K25 DK097279 / DK / NIDDK NIH HHS / United States
K23HD068400 / HD / NICHD NIH HHS / United States