Variation in Performance of Neonatal Intensive Care Units in the United States

Horbar, Jeffrey D.; Edwards, Erika M.; Greenberg, Lucy T.; Morrow, Kate A.; Soll, Roger F.; Buus‐Frank, Madge E.; Buzas, Jeffrey S.

doi:10.1001/jamapediatrics.2016.4396

Cited by 305 publications

(224 citation statements)

References 45 publications

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“…However, several complex challenges remain: (A) the twofold to fourfold variation in top and bottom quartiles for major morbidities like stages 3–4 retinopathy of prematurity and chronic lung disease persists despite ready availability of CQI tools for all,17 (B) NICUs endorse PBPs but do not consistently document compliance with such, making it difficult to ascertain cause and effect,18 (C) some important morbidities resist traditional CQI methodology (chronic lung disease and necrotising enterocolitis), suggesting crucial biological, cognitive and/or cultural limitations are yet to be elucidated1 and (D) value (health benefit divided by cost) is infrequently reported in CQI publications, adding to the perplexity of astute resource utilisation in this era of increasing financial constraints 3 17 18…”

Section: Discussionmentioning

confidence: 99%

Using a composite morbidity score and cultural survey to explore characteristics of high proficiency neonatal intensive care units

Kaempf

Wang

Dunn

2018

Arch Dis Child Fetal Neonatal Ed

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Cultural, environmental and cognitive characteristics vary among NICUs perhaps more than traditional CQI methodology and PBPs, possibly explaining the inconstancy of VLBW infant morbidity reduction efforts. High proficiency NICUs foster spirited team work and camaraderie, sustained learning opportunities and support of favourable staffing that allows problem solving and widespread involvement in CQI activities.

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Section: Discussionmentioning

confidence: 99%

Using a composite morbidity score and cultural survey to explore characteristics of high proficiency neonatal intensive care units

Kaempf

Wang

Dunn

2018

Arch Dis Child Fetal Neonatal Ed

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“…22 Member NICUs in the United States contributed standardized data on all infants aged 22 to 29 weeks’ gestation or with 401 g to 1500 g birth weight who were inborn or transferred to the hospital within 28 days of birth. 23 We included 134 871 infants born from January 2014 to December 2016.…”

Section: Methodsmentioning

confidence: 99%

Racial Segregation and Inequality in the Neonatal Intensive Care Unit for Very Low-Birth-Weight and Very Preterm Infants

et al. 2019

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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.

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“…The poor understanding of its aetiology and pathophysiology3 and absence of a non-invasive diagnostic test have resulted in a lack of clarity of what constitutes ‘NEC’. Recent reports from the USA describe a fall in NEC incidence despite a rising preterm term birth rate 4. Understanding variation between different populations and over time in the incidence of this serious gastrointestinal disease is important in identifying determinants, designing preventive trials and implementing quality improvement programmes.…”

Section: Introductionmentioning

confidence: 99%

Incidence of neonatal necrotising enterocolitis in high-income countries: a systematic review

Battersby

Santhalingam

Costeloe

et al. 2018

Arch Dis Child Fetal Neonatal Ed

199

135

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Variation in Performance of Neonatal Intensive Care Units in the United States

Cited by 305 publications

References 45 publications

Using a composite morbidity score and cultural survey to explore characteristics of high proficiency neonatal intensive care units

Using a composite morbidity score and cultural survey to explore characteristics of high proficiency neonatal intensive care units

Racial Segregation and Inequality in the Neonatal Intensive Care Unit for Very Low-Birth-Weight and Very Preterm Infants

Incidence of neonatal necrotising enterocolitis in high-income countries: a systematic review

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