EARLY DISCHARGE AND INFANT MORTALITY

提前出院和婴儿死亡率

• 批准号: 6698800
• 负责人: JESSE D MALKIN
• 金额: $ 9.44万
• 依托单位: RAND CORPORATION
• 依托单位国家: 美国
• 财政年份: 2003
• 资助国家: 美国
• 起止时间: 2003-01-20 至 2005-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6698800
• 关键词: Medicare /Medicaid; age at pregnancy; clinical research; congenital cardiovascular disorder; congenital heart disorder; congenital infection; death certificates; disease /disorder proneness /risk; health care cost /financing; health care policy; health insurance; health services research tag; hospital analysis; hospital length of stay; hospital utilization; human data; infant mortality; longitudinal human study; low socioeconomic status; medical records; newborn human (0-6 weeks); outcomes research; statistics /biometry

DESCRIPTION (provided by applicant): Of the 4 million infants born in the United States each year, about 20,000 (5 out of 1,000) die during the neonatal period and another 10,000 die after the neonatal period but before their first birthday. Some of these deaths are caused by conditions that can be treated successfully if they are diagnosed promptly. One factor that may influence whether such conditions are diagnosed quickly is the length of a well-appearing newborn's postpartum stay, because signs of congenital heart disease, infection, and other health problems may not be evident until two or more days after delivery. Although many studies have examined health effects of early postpartum discharge, few studies have considered mortality as an outcome. The investigators propose to assess the association between early discharge and neonatal mortality using an administrative database from California that captures about three million births between 1991 and 1999. The primary objective of the proposed analysis is to test the hypothesis that newborns discharged early are at increased risk of dying during the neonatal period relative to newborns with longer stays. The investigators will perform unadjusted analyses, multivariate analyses to control for observed confounders, and instrumental variable estimation to mitigate biases due to unobserved confounders. The investigators will also perform analyses of high-risk sub-populations. The secondary objective of the proposed analysis is to test the hypothesis that newborns discharged early are at increased risk of hospital readmissions during the neonatal period relative to newborns with longer stays. The investigators will also describe time trends in early discharge, neonatal mortality, and hospital readmission rates. An improved understanding of these issues will provide policymakers, health plans, hospitals, providers, and patients with information that can be used to help make more informed decisions about newborn lengths of stay.

描述（由申请人提供）：在美国每年出生的400万婴儿中，约有2万（千分之五）在新生儿期死亡，另有1万在新生儿期之后但在一周岁之前死亡。其中一些死亡是由如果及时诊断可以成功治疗的病症造成的。影响这种情况能否迅速诊断的一个因素可能是产后良好新生儿的住院时间，因为先天性心脏病、感染和其他健康问题的迹象可能要在分娩后两天或更长的时间才会明显。虽然许多研究已经调查了产后早期出院对健康的影响，但很少有研究将死亡率作为结果。研究人员建议使用加利福尼亚的一个行政数据库来评估早产和新生儿死亡率之间的关系，该数据库收集了1991年至1999年间约300万新生儿的数据。所提出的分析的主要目的是检验一个假设，即早期出院的新生儿在新生儿期死亡的风险相对于住院时间较长的新生儿增加。研究人员将进行未调整分析、多变量分析以控制观察到的混杂因素，以及工具变量估计以减轻由于未观察到的混杂因素造成的偏差。调查人员还将对高危亚人群进行分析。所提出的分析的第二个目的是检验一个假设，即早期出院的新生儿在新生儿期相对于住院时间较长的新生儿，再入院的风险增加。研究人员还将描述早期出院、新生儿死亡率和医院再入院率的时间趋势。更好地了解这些问题将为决策者、卫生计划、医院、提供者和患者提供信息，帮助他们就新生儿的住院时间做出更明智的决定。