|Title||Variations in definitions of mortality have little influence on neonatal intensive care unit performance ratings.|
|Publication Type||Journal Article|
|Year of Publication||2013|
|Authors||Profit J, Gould JB, Draper D, Zupancic JAF, Kowalkowski MA, Woodard LC, Pietz K, Petersen LA|
|Date Published||2013 Jan|
|Keywords||Cross-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|
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.
|Alternate Journal||J. Pediatr.|
|PubMed Central ID||PMC3782108|
|Grant List||K23 HD056298 / HD / NICHD NIH HHS / United States|