Are neonatal intensive care resources located according to need? Regional variation in neonatologists, beds, and low birth weight newborns
Are neonatal intensive care resources located according to need? Regional variation in neonatologists, beds, and low birth weight newborns
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DOI：
10.1542/peds.108.2.426
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发表时间：
2001-08-01
期刊：
影响因子：
8
通讯作者：
Chang, CH
中科院分区：
文献类型：
--
作者：
Goodman, DC;Fisher, ES;Chang, CH
Objective.尽管在过去的30年中，新生儿重症监护有了显著的增长，但尚不清楚产科医生和床位是否优先位于新生儿风险更大的地区。本研究报告的关系，区域措施的重症监护能力和低出生体重儿使用新开发的市场为基础的地区新生儿重症监护。246个新生儿重症监护区（NICR）的横断面小面积分析。数据来源。1996年美国医学协会和美国骨病协会临床活跃的骨科医生的主文件数据; 1999年美国儿科学会围产期儿科调查美国新生儿重症监护病房主任的回应率为100%; 1995年出生/死亡数据。NICR中每名产科医生的总分娩数范围为390至8197（中位数：1722），每张重症监护床的总分娩数范围为72至1319（中位数：317）。NICR中的能力测量和低出生体重率之间的关联具有统计学意义，但可以忽略不计（R-2：产科医生为0.04;床位为0.05）。在具有最大产科医生能力的五分位数中的NICR（平均每名产科医生仅863例分娩）的极低出生体重（VLBW）率为1.5%，而在具有最低产科医生能力的五分位数中的NICR（平均每名产科医生3718例分娩）的VLBW率为1.3%;在重症监护床位能力的五分位数中，VLBW率同样缺乏有意义的差异。包括中级供应商和中级护理病床的分析并没有改变的结果。新生儿重症监护能力并不优先设在以低出生体重率衡量的新生儿需求较大的地区。更大的能力是否能给新生儿带来好处还不清楚。
Objective. Despite marked growth in neonatal intensive care during the past 30 years, it is not known if neonatologists and beds are preferentially located in regions with greater newborn risk. This study reports the relationship between regional measures of intensive care capacity and low birth weight infants using newly developed market-based regions of neonatal intensive care.Design. Cross-sectional small-area analysis of 246 neonatal intensive care regions (NICRs).Data Sources. 1996 American Medical Association and American Osteopathic Association masterfiles data of clinically active neonatologists; 1999 American Academy of Pediatrics Section on Perinatal Pediatrics survey of directors of neonatal intensive care units in the United States with 100% response rate; 1995 linked birth/death data.Results. The number of total births per neonatologist across NICRs ranged from 390 to 8197 (median: 1722) and the number of total births per intensive care bed ranged from 72 to 1319 (median: 317). The associations between capacity measures and low birth weight rates across NICRs were statistically significant but negligible (R-2 : 0.04 for neonatologists; 0.05 for beds). NICRs in the quintile with the greatest neonatologist capacity (average of only 863 births per neonatologist) had very low birth weight (VLBW) rates of 1.5% while those in the quintile of lowest neonatologist capacity (average of 3718 births per neonatologist) had VLBW rates of 1.3%; a similar lack of meaningful difference in VLBW rates was noted across quintiles of intensive care bed capacity. Including midlevel providers and intermediate care beds to the analyses did not alter the findings.Conclusions. Neonatal intensive care capacity is not preferentially located in regions with greater newborn need as measured by low birth weight rates. Whether greater capacity affords benefits to the newborns remains unknown.