THE EFFECTS OF PATIENT VOLUME AND LEVEL OF CARE ON NEONATAL MORTALITY: IS COMPETITION KILLING BABIES? • 1413
| Autor: | Eric Buxton, Ciaran S. Phibbs, Janet M Bronstein, Roderic H Phibbs |
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| Rok vydání: | 1996 |
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| Zdroj: | Pediatric Research. 39:238-238 |
| ISSN: | 1530-0447 0031-3998 |
| Popis: | There was a rapid increase in the number of neonatal intensive care units(NICUs) in California in the 1980s. Most of this expansion occurred among intermediate, or level II NICUs and Community NICUs (a California classification for expanded level Ils that can provide prolonged assisted ventilation). Most of these new units and many of the existing level II units were quite small. We used the 1990 California birth/infant death cohort file(N=594,104), linked to the hospital discharge abstracts for mothers and infants. Logistic regression was used to examine the effects of patient volume and level of NICU care at the hospital of birth on neonatal mortality, controlling for sex and race of the infant, type of insurance coverage, birth weight, and maternal and neonatal diagnoses associated with increased neonatal mortality. The results indicate that level of care and patient volume both have strong effects on risk-adjusted mortality. Compared to level I hospitals, infants born in regional centers with an average patient census >15 had much lower risk-adjusted mortality (Odds Ratio=0.70, p=0.002). Smaller level Ills and both types of level Ils, regardless of patient volume, had mortality rates that were not significantly different from those at level I units. Infants insured by HMOs had mortality rates that were 30% (p=0.01) higher than those of other private insurers. Medicaid mortality was 32% (p=0.003) higher than those with private insurance. When costs or length of stay are used as the dependent variable, the larger level III units are in the middle of the range across the different types of NICUs, controlling for the other factors in the model. Further, 80% of the births in level Ils or community NICUs occur in hospitals located within 25 miles of a level III. These findings suggest that the recent competitive trends in California have had a significant adverse effect on neonatal mortality without achieving any cost savings. |
| Databáze: | OpenAIRE |
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