Readmission for neonatal jaundice in California, 1991-2000: Trends and implications
Readmission for neonatal jaundice in California, 1991-2000: Trends and implications
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DOI：
10.1542/peds.2007-1214
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发表时间：
2008-04-01
期刊：
影响因子：
8
通讯作者：
Phibbs, Ciaran S.
中科院分区：
文献类型：
--
作者：
Burgos, Anthony E.;Schmitt, Susan K.;Phibbs, Ciaran S.
OBJECTIVE.我们试图描述足月儿和晚期早产儿黄疸再入院的人群趋势、潜在危险因素和住院费用。从加州全州健康规划和发展办公室获得了婴儿队列数据，其中包含与婴儿和产妇出院总结相关的婴儿生命统计数据。通过使用多个排除标准，研究人群仅限于健康、常规出院的婴儿。所有关联的再入院均发生在出生后14天内。国际疾病分类，第九次修订，代码被用来进一步限制样本的黄疸再入院。出院记录是诊断、住院费用和住院时间信息的来源。采用医院特有的成本费用比估算医院成本，并调整至1991年。1994年后，黄疸再入院率普遍上升，1998年达到高峰，为每1 000人11.34人。在研究期间，晚期早产儿的再入院率（占所有婴儿的比例）保持在< 2/1000。与黄疸再入院可能性增加相关的因素包括胎龄34至39周，出生体重< 2500 g，男性，医疗补助或私人保险，以及亚洲种族。与黄疸再入院可能性降低相关的因素是剖宫产、分娩和黑人。所有婴儿再入院的平均费用为2764美元，中位数为1594美元。根据1994年高胆红素血症指南，黄疸的风险调整再入院率上升，1998年产后住院时间立法后下降。2000年，再入院率仍比1991年高6%。这些发现突出了新生儿生理学、社会经济学、种族或民族、公共政策、临床指南和医生实践之间的复杂关系。这些趋势数据为研究修订后的指南是否会改变实践模式或改善结果提供了必要的基线。成本数据也为预防战略提供了一个收支平衡点。
OBJECTIVE. We sought to describe population-based trends, potential risk factors, and hospital costs of readmission for jaundice for term and late preterm infants.METHODS. Birth-cohort data were obtained from the California Office of Statewide Health Planning and Development and contained infant vital statistics data linked to infant and maternal hospital discharge summaries. The study population was limited to healthy, routinely discharged infants through the use of multiple exclusion criteria. All linked readmissions occurred within 14 days of birth. International Classification of Diseases, Ninth Revision, codes were used to further limit the sample to readmission for jaundice. Hospital discharge records were the source of diagnoses, hospital charges, and length-of-stay information. Hospital costs were estimated using hospital-specific ratios of costs to charges and adjusted to 1991.RESULTS. Readmission rates for jaundice generally rose after 1994 and peaked in 1998 at 11.34 per 1000. The readmission rate for late preterm infants ( as a share of all infants) over the study period remained at < 2 per 1000. Factors associated with increased likelihood of hospital readmission for jaundice included gestational age 34 to 39 weeks, birth weight of < 2500 g, male gender, Medicaid or private insurance, and Asian race. Factors associated with a decreased likelihood of readmission for jaundice were cesarean section delivery and black race. The mean cost of readmission for all infants was $2764, with a median cost of $1594.CONCLUSIONS. Risk-adjusted readmission rates for jaundice rose following the 1994 hyperbilirubinemia guidelines and declined after postpartum length-of-stay legislation in 1998. In 2000, the readmission rate remained 6% higher than in 1991. These findings highlight the complex relationship among newborn physiology, socioeconomics, race or ethnicity, public policy, clinical guidelines, and physician practice. These trend data provide the necessary baseline to study whether revised guidelines will change practice patterns or improve outcomes. Cost data also provide a break-even point for prevention strategies.