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Variations in definitions of mortality have little influence on neonatal intensive care unit performance ratings.

CPQCC Publication
TitleVariations in definitions of mortality have little influence on neonatal intensive care unit performance ratings.
Publication TypeJournal Article
Year of Publication2013
AuthorsProfit J, Gould JB, Draper D, Zupancic JAF, Kowalkowski MA, Woodard LC, Pietz K, Petersen LA
JournalJ Pediatr
Volume162
Issue1
Pagination50-5.e2
Date Published2013 Jan
ISSN1097-6833
KeywordsCross-Sectional Studies, Female, Humans, Infant Mortality, Infant, Newborn, Infant, Very Low Birth Weight, Intensive Care Units, Neonatal, Male, Quality of Health Care, Terminology as Topic
Abstract

OBJECTIVE: To measure the influence of varying mortality time frames on performance rankings among regional neonatal intensive care units (NICUs) in a large state.

STUDY DESIGN: We performed a cross-sectional data analysis of very low birth weight infants receiving care at 24 level 3 NICUs. We tested the effect of 4 definitions of mortality: (1) death between admission and end of birth hospitalization or up to 366 days; (2) death between 12 hours of age and the end of birth hospitalization or up to 366 days; (3) death between admission and 28 days; and (4) death between 12 hours of age and 28 days. NICUs were ranked by quantifying their deviation from risk-adjusted expected mortality and dividing them into 3 tiers: top 6, bottom 6, and in between.

RESULTS: There was wide interinstitutional variation in risk-adjusted mortality for each definition (observed minus expected z-score range, -6.08 to 3.75). However, mortality-based NICU rankings and classification into performance tiers were very similar for all institutions in each of our time frames. Among all 4 definitions, NICU rank correlations were high (>0.91). Few NICUs changed relative to a neighboring tier with changes in definitions, and none changed by more than one tier.

CONCLUSION: The time frame used to ascertain mortality had little effect on comparative NICU performance.

DOI10.1016/j.jpeds.2012.06.002
Alternate JournalJ. Pediatr.
PubMed ID22854328
PubMed Central IDPMC3782108
Grant ListK23 HD056298 / HD / NICHD NIH HHS / United States