Determinants of Newborn Health and Health Care Trajectories in the First Year of Life

项目总结/摘要 近几十年来，美国的新生儿健康状况有所改善，但仍落后于其他高收入国家。 国家造成这种令人失望的差距的一个至关重要但研究不足的原因是住院病人的性质 新生儿得到的护理及其对生命第一年健康的影响。新生儿保健和 结果显示，不同医院之间以及新生儿重症监护之间的结果差异很大， 单位（NICU），但很少有人知道这种变化的原因和后果，特别是对于低风险 (e.g.,不太早产）的新生儿，他们占据了今天大多数的NICU病床;很少有研究调查了 不同的护理模式与出院后的结果有关。我们的长期目标是扩大我们以前的 描述性研究的新生儿护理变化，调查和确定的时间顺序的风险，医疗 护理，以及生命第一年的结果。我们将使用基于人口的113万人队列进行研究 医疗保险的德克萨斯州新生儿（54%的德克萨斯州出生，1/18的美国出生）。这个独特的数据集， 由我们的团队成员，链接产妇和新生儿医疗补助索赔/遭遇出生率和死亡率 记录我们的中心假设是，新生儿护理和随后的婴儿健康结果， 与新生儿和出院后护理的具体、可修改的方面相关。我们将研究五个妊娠期 年龄单胎队列：（1）极早产，（2）中度早产，（3）早期早产，（4）早期足月，和（5）足月。 在目标1中，我们将调查新生儿医院护理与医院特点的关系。然后我们将 测试这些护理模式与死亡率和发病率（严重情况，再入院， 在住院期间加上出院后7天内使用ER）。在目标2中，观察期延长至 出院后一年，其他结局如来自索赔的婴儿诊断和多个 从妇女、婴儿和儿童营养计划中获得的体重测量结果。我们将测试 这些风险调整后的结果与出生医院特征、新生儿护理和术后 新生儿护理在目标3中，我们调查了医院级别的母亲种族和 根据上述分析确定种族构成。该项目将大大提高我们对 新生儿护理和结果的一个大的，不同的总出生队列，通过生命的第一年，提供 关于早期健康决定因素的详细信息。调查结果将创造可行的机会， 通过制定政策和新的临床改进倡议，改善围产期护理服务。

PROJECT SUMMARY/ABSTRACT Newborn health has improved in the United States in recent decades yet still lags that of other high-income countries. A critically important yet understudied reason for this disappointing gap is the nature of the inpatient care received by newborns and the effects this has on health during the first year of life. Neonatal care and outcomes have been shown to vary markedly from hospital to hospital and between neonatal intensive care units (NICUs), yet little is known about the causes and consequences of this variation, particularly for lower-risk (e.g., less premature) newborns, who occupy most NICU beds today; few studies have examined how widely differing patterns of care are linked to post-discharge outcomes. Our long-term goal is to extend our previous descriptive studies of newborn-care variation to investigate and identify the temporal sequence of risk, medical care, and outcomes through the first year of life. We will do so using a population-based cohort of 1.13 million Medicaid-insured Texas newborns (54% of Texas births, 1 in 18 of US births). This unique dataset, developed by members of our team, links maternal and newborn Medicaid claims/encounters to natality and mortality records. Our central hypothesis is that newborn care, and subsequent infant health outcomes, are strongly associated with specific, modifiable aspects of newborn and post-discharge care. We will study five gestational age singleton cohorts: (1) very preterm, (2) moderately preterm, (3) early preterm, (4) early term, and (5) term. In Aim 1, we will investigate the association of neonatal hospital care with hospital characteristics. We will then test the association of these care patterns with mortality and morbidity (severe conditions, readmissions, and ER use) during the inpatient period plus 7 days post-discharge. In Aim 2, the observation period is extended to one-year post-discharge, with additional outcomes such as infant diagnoses derived from claims and multiple weight measurements obtained from the Women, Infants, and Children Nutritional Program. We will test associations of these risk-adjusted outcomes with birth-hospital characteristics, neonatal care, and post- neonatal care. In Aim 3, we investigate the possible amplifying effects of hospital-level maternal race and ethnicity composition on the foregoing analyses. This project will significantly advance our knowledge of newborn care and outcomes for a large, diverse total birth cohort through the first year of life, providing detailed information about determinants of early health. The findings will create actionable opportunities to improve perinatal care delivery through policy development and new clinical improvement initiatives.