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 |
Journal | J Pediatr |
Volume | 162 |
Issue | 1 |
Pagination | 50-5.e2 |
Date Published | 2013 Jan |
ISSN | 1097-6833 |
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 |
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. |
DOI | 10.1016/j.jpeds.2012.06.002 |
Alternate Journal | J. Pediatr. |
PubMed ID | 22854328 |
PubMed Central ID | PMC3782108 |
Grant List | K23 HD056298 / HD / NICHD NIH HHS / United States |