United States and territory policies supporting maternal and neonatal transfer: review of transport and reimbursement

Okoroh, Ekwutosi M.; Kroelinger, Charlan D.; Lasswell, Sarah M.; Goodman, David A.; Williams, Alison; Barfield, Wanda D.

doi:10.1038/jp.2015.109

Cited by 29 publications

(14 citation statements)

References 43 publications

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“…Few studies have focused on interfacility transport in neonatal populations. 11,[15][16][17] In agreement with previous studies, a low GA was the most significant factor associated with adverse short-term outcomes in our cohort. Additionally, low birth weight and birth by cesarean section tended to be associated with adverse outcomes, although the differences were not statistically significant.…”

Section: Discussionsupporting

confidence: 92%

Impact of Time to Neonatal Transport on Outcomes of Transient Tachypnea of the Newborn

et al. 2018

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Objective To assess effects of neonatal transport on transient tachypnea of the newborn (TTN) in outborn term neonates. Study Design This retrospective cohort study included 66 term neonates diagnosed with TTN and transported to the Osaka Women's and Children's Hospital neonatal intensive care unit between January 2003 and March 2018. A multivariate logistic regression analysis identified perinatal and neonatal transport factors associated with adverse short-term outcomes defined as mechanical ventilation >48 hours, continuous positive airway pressure >72 hours, pulmonary hemorrhage, and requirement for inhaled nitric oxide, thoracentesis, or surfactant replacement therapy. Results A lower gestational age (GA) (37.7 [37.2, 38.3] vs. 39.6 [37.8, 40.3] weeks, p = 0.002), longer time to neonatal transport (10.0 [4.3, 25.5] vs. 5.5 [2.7, 9.7] hours, p = 0.01), and higher respiratory rates during transport (70 [60, 85] vs. 60 [55, 78.8] breaths/min, p = 0.04) were significantly associated with adverse short-term outcomes. After adjusting for GA, sex, cesarean section, and time to neonatal transport, GA (odds ratio [OR], 0.37; 95% confidence interval [CI], 0.24–0.87) and time to neonatal transport (OR, 1.07; 95% CI, 1.01–1.13) were significantly associated with adverse outcomes. Conclusion Short-term adverse prognosis of TTN is strongly associated with a lower GA and longer time between birth and neonatal transport.

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Section: Discussionsupporting

confidence: 92%

Impact of Time to Neonatal Transport on Outcomes of Transient Tachypnea of the Newborn

et al. 2018

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“…Using a U.S. national-level data set containing 9,722 VLBW infant transfers among 2,122 hospitals, we found a variety of different types of communities, varying from highly centralized to highly regionalized. That we found strongly regionalized networks is perhaps not surprising given the financial incentives of the health care market, the differences in state regulations governing NICU expansion, and geography [3,4,10,11,12,13,6]. Our communities were largely organized around state boundaries, but 25% of communities overlapped at least four states and 8% of all transfers occurred between hospitals in different states.…”

Section: Discussionmentioning

confidence: 72%

“…To advance our understanding of top-down vs. bottom-up processes in hospital transfer networks more specifically, and complex systems more generally, an important extension of this work is to analyze how the VLBW infant transfer network structure has changed over time; in particu-lar, whether changes in state-level policies on transport or changes in reimbursement and financial incentives are associated with the types of changes in network structure predicted by our results. However, one important policy implication of the current research shows that VLBW transfers cross state borders while states policies/regulations governing maternal and neonatal transport do not [11]. The associations between existing state laws and community structure remain an important part of future research.…”

Section: Discussionmentioning

confidence: 90%

“…This growth has led to the deregionalization of care, the proliferation of smaller maternity centers and NICUs, and the uneven distribution of perinatal resources unrelated to regional requirements [5,6,7,8]. Regionalization models, regulations, and measures of risk-appropriate care for high risk infants vary widely among states [9,4,10,11,12,13].…”

Section: Introductionmentioning

confidence: 99%

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The interhospital transfer network for very low birth weight infants in the United States

et al. 2018

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Very low birth weight (VLBW) infants require specialized care in neonatal intensive care units. In the United States (U.S.), such infants frequently are transferred between hospitals. Although these neonatal transfer networks are important, both economically and for infant morbidity and mortality, the national level pattern of neonatal transfers is largely unknown. Using data from Vermont Oxford Network on 44,753 births, 2122 hospitals, and 9722 interhospital infant transfers from 2015, we performed the largest analysis to date on the interhospital transfer network for VLBW infants in the U.S. We find that transfers are organized around regional communities, but that despite being largely within state boundaries, most communities often contain at least two hospitals in different states. To classify the structural variation in transfer pattern amongst these communities, we applied a spectral measure for regionalization and found an association between a community's degree of regionalization and their infant transfer rate, which was not utilized in detecting communities. We also demonstrate that the established measures of network centrality and hierarchy, e.g., the community-wide entropy in PageRank or betweenness centrality and number of distinct "layers, " within a community, correlate weakly with our regionalization index and were not significantly associated with metrics on infant transfer rate. Our results suggest that the regionalization index captures novel information about the structural properties of VLBW infant transfer networks, have the practical implication of characterizing neonatal care in the U.S., and may apply more broadly to the role of centralizing forces in organizing complex adaptive systems.

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“…Transferring infants who no longer requireintensive care to community hospitals closer to home has many potential advantages, including decreased family stress, earlier involvement of primary providers, and more efficient use of resources within a care network. [20][21][22][23][24] Prior studies suggest that transfer of stable, recovering infants to lower level special care nurseries is safe and cost effective, 25,26 particularly when they will spend >1 week in the community hospital. 27 Although some cost savings may be offset by a trend toward longer length of stay in the community hospital, 26 others have shown that overall length of stay is similar to that of the referring NICU for low birth weight infants 23,28 Times of high patient volume or acuity may create the need to identify which infants have least need for high-level ICU services and would be the best candidates for retro-transfer.…”

mentioning

confidence: 99%

Predicting Successful Neonatal Retro-Transfer to a Lower Level of Care

Kunz

Dukhovny

Profit

et al. 2019

The Journal of Pediatrics

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Up to 20% of newborn infants retro-transferred to a lower level of care require readmission to a higher-level facility. In this study, we developed and validated a prediction rule (The Rule for Elective Transfer between Units for Recovering Neonates) to identify clinical characteristics of infants at risk for failing retro-transfer. In the 1970s, regionalization of neonatal care was proposed in the United States as a strategy to improve neonatal outcomes. 1-6 Regionalization emphasizes the importance of matching patients with health care facilities that are able to provide an appropriate level of care. 1 The American Academy of Pediatrics (AAP) has defined levels of care for neonatal intensive care units (NICUs), ranging from Level I units (well newborn nurseries) to Level IV units (regional NICUs with pediatric surgical subspecialists). 7 Recent changes in the landscape of health care in the United States, such as the establishment of Accountable Care Organizations, have brought the importance of responsibility for care within regional networks to the forefront. 8 However, there has been a trend toward expansion of community hospital services to include care for sicker infants, effectively deregionalizing systems of neonatal care. 9-13 This shift further emphasizes the need for neonatal transfers to be both appropriate and well-planned.

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United States and territory policies supporting maternal and neonatal transfer: review of transport and reimbursement

Cited by 29 publications

References 43 publications

Impact of Time to Neonatal Transport on Outcomes of Transient Tachypnea of the Newborn

Impact of Time to Neonatal Transport on Outcomes of Transient Tachypnea of the Newborn

The interhospital transfer network for very low birth weight infants in the United States

Predicting Successful Neonatal Retro-Transfer to a Lower Level of Care

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