Hospital and patient characteristics associated with variation in 28-day mortality rates for very low birth weight infants
Hospital and patient characteristics associated with variation in 28-day mortality rates for very low birth weight infants
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DOI：
10.1542/peds.99.2.149
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发表时间：
1997-02-01
期刊：
影响因子：
8
通讯作者：
Shiono, PH
中科院分区：
文献类型：
--
作者：
Horbar, JD;Badger, GJ;Shiono, PH
背景资料。极低出生体重儿的结局因新生儿重症监护病房(NICU)的不同而不同，但这种差异的原因尚不清楚。我们使用一个大型新生儿研究网络的数据库来确定婴儿的入院特征或单元的特定特征是否可以解释观察到的不同单元间新生儿死亡率的差异。我们研究了1991年至1992年期间在参加佛蒙特州牛津网络数据库的62个NICU治疗的7672名出生体重在501到1500克之间的婴儿。总体而言，14.7%的研究婴儿在出生后28天内死亡(四分位数范围在9.9%到18.1%之间)。在NICU观察到的死亡人数与根据在NICU接受治疗的婴儿的特征预测的死亡人数的比率(标准化新生儿死亡率，[SNMR])在不同单位之间差异很大(范围从0到1.69，z=4.24)。年患者数量与死亡率(r=0.17)或SNMR(r=0.22)之间没有关联。有儿科住院医师培训计划的24家医院的观察死亡率(17%比13%)和SNMR(1.04比.87)都高于没有这类计划的38家医院。有住院医师计划的医院的年平均病人数量更高(104比66)。在同时调整患者特征、容量和是否存在住院医师计划的分析中，无论是容量(每额外治疗10个病例的优势比[OR]1.01，95%可信区间[CI]，0.98至1.04)，还是儿科住院医师计划的存在(OR 1.18，95%CI，0.94至1.47)与新生儿死亡风险均无显著关联。新生儿死亡率在NICU之间存在差异，这不能用测量的婴儿入院特征的差异来解释，这表明医疗保健的有效性在不同的单位有所不同。在一个单位接受治疗的极低出生体重儿的年数量和儿科住院医师培训计划的存在都不与极低出生体重儿的新生儿死亡率独立相关。
Background. The outcomes for very low birth weight infants vary among neonatal intensive care units (NICUs), but the reasons for this variation are not well understood. We used the database of a large neonatology research network to determine whether either admission characteristics of the infants or specific characteristics of the units such as annual patient volume and the presence of a pediatric residency program could account for observed differences in neonatal mortality rates among units.Methods. We studied 7672 infants with birth weights from 501 to 1500 g treated during 1991 and 1992 at 62 NICUs participating in the Vermont Oxford Network Database.Results. Overall, 14.7% of the study infants died within 28 days of birth (interquartile range 9.9% to 18.1%). The ratio of the number of observed deaths at an NICU to the number of deaths predicted based on the characteristics of infants treated at the NICU (standardized neonatal mortality ratio, [SNMR]) varied significantly among units (range 0 to 1.69, z = 4.24). There was no association between annual patient volume and either mortality rate (r = .17) or SNMR (r = .22). Observed mortality rates (17% vs 13%) and SNMR (1.04 vs .87) were both higher at the 24 hospitals with pediatric residency training programs than at the 38 hospitals without such programs. Hospitals with residency programs had higher average annual patient volumes (104 vs 66). In an analysis simultaneously adjusting for patient characteristics, volume, and presence of a residency program, neither volume (odds ratio [OR] per 10 additional cases treated 1.01, 95% confidence interval [CI], .98 to 1.04) nor presence of a pediatric residency program (OR 1.18, 95% CI, .94 to 1.47) was significantly associated with neonatal mortality risk.Conclusion. There are differences in neonatal mortality rates among NICUs that cannot be explained by differences in the measured admission characteristics of the infants, suggesting that the effectiveness of medical care varies among units. Neither the annual volume of very low birth weight infants treated in a unit nor the presence of a pediatric residency training program was independently associated with neonatal mortality rates for very low birth weight infants.