Neonatal Intensive Care Variation in Medicaid-Insured Newborns: A Population-Based Study.
J Pediatr
; 209: 44-51.e2, 2019 06.
Article
em En
| MEDLINE
| ID: mdl-30955790
ABSTRACT
OBJECTIVE:
To assess the contribution of maternal and newborn characteristics to variation in neonatal intensive care use across regions and hospitals. STUDYDESIGN:
This was a retrospective population-based live birth cohort of newborn infants insured by Texas Medicaid in 2010-2014 with 2 subcohorts very low birth weight (VLBW) singletons and late preterm singletons. Crude and risk-adjusted neonatal intensive care unit (NICU) admission rates, intensive and intermediate special care days, and imaging procedures were calculated across Neonatal Intensive Care Regions (n = 21) and hospitals (n = 100). Total Medicaid payments were calculated.RESULTS:
Overall, 11.5% of live born, 91.7% of VLBW, and 37.6% of infants born late preterm were admitted to a NICU, receiving an average of 2 days, 58 days, and 5 days of special care with payments per newborn inpatient episode of $5231, $128â075, and $10â837, respectively. There was little variation across regions and hospitals in VLBW NICU admissions but marked variation for NICU admissions in late preterm newborn infants and for special care days and imaging rates in all cohorts. The variation decreased slightly after health risk adjustment. There was moderate substitution of intermediate for intensive care days across hospitals (Pearson r VLBW -0.63 P < .001; late preterm newborn -0.53 P < .001).CONCLUSIONS:
Across all risk groups, the variation in NICU use was poorly explained by differences in newborn illness levels and is likely to indicate varying practice styles. Although the "right" rates are uncertain, it is unlikely that all of these use patterns represent effective and efficient care.Palavras-chave
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Unidades de Terapia Intensiva Neonatal
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Medicaid
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Recém-Nascido de muito Baixo Peso
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Pesquisas sobre Atenção à Saúde
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Nascimento Prematuro
Tipo de estudo:
Etiology_studies
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Incidence_studies
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Observational_studies
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Risk_factors_studies
Limite:
Female
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Humans
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Infant
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Male
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Newborn
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Pregnancy
País como assunto:
America do norte
Idioma:
En
Ano de publicação:
2019
Tipo de documento:
Article