Care practices and neonatal survival in 52 neonatal intensive care units in Telangana and Andhra Pradesh, India: A cross-sectional study

Autor: Swecha Chamarty, Mukta Tyagi, Rajan Shukla, Claudia Hanson, Karen Zamboni, Samiksha Singh, Joanna Schellenberg
Jazyk: angličtina
Rok vydání: 2019
Předmět:
Time Factors
Cross-sectional study
Physiology
Health Care Providers
Nurses
030204 cardiovascular system & hematology
Pediatrics
Neonatal Care
0302 clinical medicine
Patient Admission
Risk Factors
Case fatality rate
Infant Mortality
Medicine and Health Sciences
Medicine
Birth Weight
030212 general & internal medicine
Medical Personnel
Hospital Mortality
education.field_of_study
Delivery of Health Care
Integrated
Mortality rate
Public sector
General Medicine
Hospitals
Intensive Care Units
Professions
Treatment Outcome
Physiological Parameters
Practice Guidelines as Topic
Guideline Adherence
Research Article
medicine.medical_specialty
Referral
Death Rates
Population
Personnel Staffing and Scheduling
India
Risk Assessment
Hospitals
Private
03 medical and health sciences
Case mix index
Population Metrics
Intensive care
Intensive Care Units
Neonatal
Humans
Healthcare Disparities
education
Quality Indicators
Health Care
Population Biology
business.industry
Hospitals
Public
Body Weight
Biology and Life Sciences
Neonates
Infant
Health Care
Cross-Sectional Studies
Health Care Facilities
Family medicine
People and Places
Intensive Care
Neonatal
Population Groupings
Neonatology
business
Developmental Biology
Zdroj: PLoS Medicine
PLoS Med
PLoS Medicine, Vol 16, Iss 7, p e1002860 (2019)
ISSN: 1549-1676
1549-1277
Popis: Background The Indian government supports both public- and private-sector provision of hospital care for neonates: neonatal intensive care is offered in public facilities alongside a rising number of private-for-profit providers. However, there are few published reports about mortality levels and care practices in these facilities. We aimed to assess care practices, causes of admission, and outcomes from neonatal intensive care units (NICUs) in public secondary and private tertiary hospitals and both public and private medical colleges enrolled in a quality improvement collaborative in Telangana and Andhra Pradesh—2 Indian states with a respective population of 35 and 50 million. Methods and findings We conducted a cross-sectional study between 30 May and 26 August 2016 as part of a baseline evaluation in 52 consenting hospitals (26 public secondary hospitals, 5 public medical colleges, 15 private tertiary hospitals, and 6 private medical colleges) offering neonatal intensive care. We assessed the availability of staff and services, adherence to evidence-based practices at admission, and case fatality after admission to the NICU using a range of tools, including facility assessment, observations of admission, and abstraction of registers and telephone interviews after discharge. Our analysis is adjusted for clustering and weighted for caseload at the hospital level and presents findings stratified by type and ownership of hospitals. In total, the NICUs included just over 3,000 admissions per month. Staffing and infrastructure provision were largely according to government guidelines, except that only a mean of 1 but not the recommended 4 paediatricians were working in public secondary NICUs per 10 beds. On admission, all neonates admitted to private hospitals had auscultation (100%, 19 of 19 observations) but only 42% (95% confidence interval [CI] 25%–62%, p-value for difference is 0.361) in public secondary hospitals. The most common single cause of admission was preterm birth (25%) followed by jaundice (23%). Case-fatality rates at age 28 days after admission to a NICU were 4% (95% CI 2%–8%), 15% (9%–24%), 4% (2%–8%) and 2% (1%–5%) (Chi-squared p = 0.001) in public secondary hospitals, public medical colleges, private tertiary hospitals, and private medical colleges, respectively, according to facility registers. Case fatality according to postdischarge telephone interviews found rates of 12% (95% CI 7%–18%) for public secondary hospitals. Roughly 6% of admitted neonates were referred to another facility. Outcome data were missing for 27% and 8% of admissions to private tertiary hospitals and private medical colleges. Our study faced the limitation of missing data due to incomplete documentation. Further generalizability was limited due to the small sample size among private facilities. Conclusions Our findings suggest differences in quality of neonatal intensive care and 28-day survival between the different types of hospitals, although comparison of outcomes is complicated by differences in the case mix and referral practices between hospitals. Uniform reporting of outcomes and risk factors across the private and public sectors is required to assess the benefits for the population of mixed-care provision.
Claudia Hanson and colleagues, part of the High Quality Care Commission assess care and outcomes in hospitals for neonates in 2 large states in India
Author summary Why was this study done? The Indian government supports provision of neonatal intensive care for neonates in both public and private hospitals. High mortality after admission to public neonatal intensive care units (NICUs) has been described from facilities in India. Although it is often assumed that care is better in private rather than public facilities, studies in India and elsewhere do not provide a clear answer on this. What did the researchers do and find? We compared 26 public secondary hospitals, 5 public medical colleges, 15 private tertiary hospitals, and 6 private medical colleges, which together constitute roughly two-thirds of NICUs in Telangana and Andhra Pradesh, 2 Indian states with a respective population of 35 and 50 million. Equipment, supplies, and staffing were according to government guidelines except that rooms allowing mothers to breastfeed or to lie down for Kangaroo Mother Care were not available in all hospitals. Also, government hospitals had only 1 instead of 4 paediatricians per 10 beds as recommended in government guidelines. Admission care processes were substandard in relation to auscultation and temperature measurement, particularly in public facilities. Analysing 6,859 register records, we observed that 4%, 15%, 4%, and 2% of neonates admitted in public secondary hospitals, public medical colleges, private tertiary hospitals, and private medical colleges, respectively, died by the age of 28 days. However, analysis was complicated by a large number of missing records, which was more common in private than public facilities. What do these findings mean? The survival of neonates admitted to NICUs is better than previously described in Telangana and Andhra Pradesh. Comparison between private and public facilities is complicated by missing information both on outcomes and patient characteristics such as gestational age. Improved documentation and standardisation of registers in both the private and public sectors is essential for comparison between public and private hospitals.
Databáze: OpenAIRE
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