IMPORTANCE Hospitals use rates from the best quartile or decile as benchmarks for quality improvement aims, but to what extent these aims are achievable is uncertain.OBJECTIVE To determine the proportion of neonatal intensive care units (NICUs) in 2014 that achieved rates for death and major morbidities as low as the shrunken adjusted rates from the best quartile and decile in 2005 and the time it took to achieve those rates.
IMPORTANCE Racial and ethnic minorities receive lower-quality health care than white non-Hispanic individuals in the United States. Where minority infants receive care and the role that may play in the quality of care received is unclear. OBJECTIVE To determine the extent of segregation and inequality of care of very low-birth-weight and very preterm infants across neonatal intensive care units (NICUs) in the United States. DESIGN, SETTING, AND PARTICIPANTS This cohort study of 743 NICUs in the Vermont Oxford Network included 117 982 black, Hispanic, Asian, and white infants born at 401 g to 1500 g or 22 to 29 weeks’ gestation from January 2014 to December 2016. Analysis began January 2018. MAIN OUTCOMES AND MEASURES The NICU segregation index and NICU inequality index were calculated at the hospital level as the Gini coefficients associated with the Lorenz curves for black, Hispanic, and Asian infants compared with white infants, with NICUs ranked by proportion of white infants for the NICU segregation index and by composite Baby-MONITOR (Measure of Neonatal Intensive Care Outcomes Research) score for the NICU inequality index. RESULTS Infants (36 359 black [31%], 21 808 Hispanic [18%], 5920 Asian [5%], and 53 895 white [46%]) were segregated among the 743 NICUs by race and ethnicity (NICU segregation index: black: 0.50 [95% CI, 0.46–0.53], Hispanic: 0.58 [95% CI, 0.54–0.61], and Asian: 0.45 [95% CI, 0.40–0.50]). Compared with white infants, black infants were concentrated at NICUs with lower-quality scores, and Hispanic and Asian infants were concentrated at NICUs with higher-quality scores (NICU inequality index: black: 0.07 [95% CI, 0.02–0.13], Hispanic: −0.10 [95% CI, −0.17 to −0.04], and Asian: −0.26 [95% CI, −0.32 to −0.19]). There was marked variation among the census regions in weighted mean NICU quality scores (range: −0.69 to 0.85). Region of residence explained the observed inequality for Hispanic infants but not for black or Asian infants. CONCLUSIONS AND RELEVANCE Black, Hispanic, and Asian infants were segregated across NICUs, reflecting the racial segregation of minority populations in the United States. There were large differences between geographic regions in NICU quality. After accounting for these differences, compared with white infants, Asian infants received care at higher-quality NICUs and black infants, at lower-quality NICUs. Explaining these patterns will require understanding the effects of sociodemographic factors and public policies on hospital quality, access, and choice for minority women and their infants.
Key Points Question For infants born at the edge of viability who received postnatal life support, was the administration of antenatal steroids associated with higher rates of survival? Finding In a cohort study of 33 472 infants born at 22 to 25 weeks’ gestation between 2012 and 2016, the concordant receipt of antenatal steroids and postnatal life support was significantly associated with higher rates of survival compared with postnatal life support alone. Meaning There is an opportunity for reevaluation of national guidelines, allowing for shared decision making with concordant obstetrical and neonatal treatment plans.
NRN) extremely preterm birth outcome model is widely used for prognostication by practitioners caring for families expecting extremely preterm birth. The model provides information on mean outcomes from 1998 to 2003 and does not account for substantial variation in outcomes among US hospitals. OBJECTIVE To update and validate the NRN extremely preterm birth outcome model for most extremely preterm infants in the United States.
Defendants who are accused of serious crimes sometimes feign amnesia to evade criminal responsibility. Previous research has suggested that feigning amnesia might impair subsequent recall. In two experiments, participants read and heard a story about a central character, described as "you," who was responsible for the death of either a puppy (Experiment 1) or a friend (Experiment 2). On free and cued recall tests immediately after the story, participants who had feigned amnesia recalled less than did participants who had recalled accurately. One week later, when all participants recalled accurately, participants who had previously feigned amnesia still performed worse than did participants who had recalled accurately both times. However, the participants who had formerly feigned amnesia did not perform worse than did a control group who had received only the delayed recall tests. Our results suggest that a "feigned amnesia effect" may reflect nothing more than differential practice at recall. Feigning amnesia for a crime need not impair memory for that crime when a person later seeks to remember accurately.
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