The Relation Between the Availability of Neonatal Intensive Care and Neonatal Mortality

Goodman, David C.; Little, George A.; Stukel, Thérèse A.; Chang, Chiang‐Hua; Schoendorf, Kenneth S

doi:10.1097/00006254-200211000-00010

Cited by 37 publications

(60 citation statements)

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“…This plateau effect has been seen in other studies of the physician workforce. 10,16,20 Moreover, prostate cancer can be relatively indolent, in contrast to cervical cancer or head and neck cancers. Patients residing in areas with an oversubscribed radiation oncologist can potentially wait until prostate cancer treatment is available, perhaps mitigating the need for additional radiation oncologists to improve time between diagnosis and treatment.…”

Section: Discussionmentioning

confidence: 99%

The impact of county-level radiation oncologist density on prostate cancer mortality in the United States

Aneja

2012

Prostate Cancer Prostatic Dis

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Section: Discussionmentioning

confidence: 99%

The impact of county-level radiation oncologist density on prostate cancer mortality in the United States

Aneja

2012

Prostate Cancer Prostatic Dis

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“…[1][2][3]5,10 First, the majority of these studies evaluated hospital level of care alone on the risk of perinatal mortality and did not account for confounding by hospital site of delivery. 3,5,10 Two of the more recent studies, both of which were performed by members of our group, have evaluated the effect of hospital level of care and hospital volume on mortality of very low birth weight infants by disaggregating these factors, treating them as fixed effects at the individual level, and then using traditional, individual level statistical tools for the analyses. 1,2 One potential pitfall of using individual-level statistical techniques (logistic regression) to evaluate hospital-level factors is that cluster correlation at the hospital level may not be fully accounted, causing the potential to overestimate the effects of hospital-level factors.…”

Section: Discussionmentioning

confidence: 99%

“…1,2 However, owing to the increased availability of technology and trained personnel, there has been a dissemination of specialty perinatal and neonatal services beyond large, centralized academic centers. [3][4][5] In California, this trend has manifested as an increased number of midlevel neonatal intensive care units.…”

Section: Introductionmentioning

confidence: 99%

Examining the effect of hospital-level factors on mortality of very low birth weight infants using multilevel modeling

et al. 2011

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Objective: The objective of this study was to examine the effect of hospitallevel factors on mortality of very low birth weight infants using multilevel modeling.Study Design: This is a secondary data analysis of California maternal-infant hospital discharge data from 1997 to 2002. The study population was limited to singleton, non-anomalous, very low birth weight infants, who delivered in hospitals providing neonatal intensive care services (level-2 and higher). Hierarchical generalized linear modeling, also known as multilevel modeling, was used to adjust for individual-level confounders.Result: In a multilevel model, increasing hospital volume of very low birth weight deliveries was associated with lower odds of very low birth weight mortality. Characteristics of a particular hospital's obstetrical and neonatal services (the presence of residency and fellowship training programs and the availability of perinatal and neonatal services) had no independent effect. Conclusion: Using multilevel modeling, hospital volume of very low birth weight deliveries appears to be the primary driver of reduced mortality among very low birth weight infants.

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“…[41][42][43] These complexities and paradoxes of over resourcing are illustrated by several studies from the United States. 44,45 Closure of small rural hospitals has undoubtedly a negative effect on communities. 4,11,46 It denies women the opportunity to give birth close to where they live, and this may not be cost effective.…”

Section: Discussionmentioning

confidence: 99%

General obstetrics: Does size matter? A population‐based study of birth in lower volume maternity hospitals for low risk women

Tracy

Sullivan

Dahlen

et al. 2005

BJOG

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Objective To study the association between volume of hospital births per annum and birth outcome for low risk women.Design Population‐based study using the National Perinatal Data Collection (NPDC).Setting Australia.Participants Of 750,491 women who gave birth during 1999–2001, there were 331,147 (47.14%) medically ‘low risk’ including 132,696 (40.07%) primiparae and 198,451 (59.93%) multiparae.Methods The frequency of each birth and infant outcome was described according to the size of the hospital where birth took place. We investigated whether unit size (defined by volume) was an independent risk factor for each outcome factor using public hospitals with greater than 2000 births per annum as a reference point.Main outcome measures Rates of intervention at birth and neonatal mortality for low risk women in relation to hospitals with <100, 100–500, 501–1000, 1001–2000 and >2001 births per annum.Results Neonatal death was less likely in hospitals with less than 2000 births per annum regardless of parity. For multiparous low risk women in hospitals of 100 and 500 births per annum compared with hospitals of >2000 births per annum the adjusted odds of neonatal mortality [adjusted odds ratio (AOR) 0.36; 99% confidence interval (CI) 0.14–0.93]. For low risk primiparous women in hospitals with less than 100 births per annum, there were lower rates of induction of labour (AOR 0.62; 99% CI 0.54–0.73); intrathecal analgesia/anaesthesia (AOR 0.34; 99% CI 0.28–0.42); instrumental birth (AOR 0.80; 99% CI 0.69–0.93); caesarean section after labour (AOR 0.59; 99% CI 0.49–0.72) and admission to a neonatal unit (AOR 0.15; 99% CI 0.10–0.22) and for low risk multiparous women in hospitals with less than 100 births per annum: induction (AOR 0.69; 99% CI 0.62–0.76); intrathecal analgesia/anaesthesia (AOR 0.32; 99% CI 0.29–0.36); instrumental birth (AOR 0.52; 99% CI 0.41–0.67); caesarean section after labour (AOR 0.41; 99% CI 0.33–0.52); and admission to a neonatal unit (AOR 0.09; 99% CI 0.07–0.12).Conclusions In Australia, lower hospital volume is not associated with adverse outcomes for low risk women.

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The Relation Between the Availability of Neonatal Intensive Care and Neonatal Mortality

Cited by 37 publications

References 0 publications

The impact of county-level radiation oncologist density on prostate cancer mortality in the United States

The impact of county-level radiation oncologist density on prostate cancer mortality in the United States

Examining the effect of hospital-level factors on mortality of very low birth weight infants using multilevel modeling

General obstetrics: Does size matter? A population‐based study of birth in lower volume maternity hospitals for low risk women

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