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Level of care not associated with quality of care in NICUs
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The level of care for very low-birth-weight infants in neonatal ICUs, determined by the 2012 AAP Guidelines, was not associated with the significant variance in the quality of care, according to recent findings published in Pediatrics.
“There continues to be astounding variation in care and outcomes of very low-birth-weight infants across NICUs,” Jochen Profit, MD, MPH, in the department of pediatrics at Stanford University School of Medicine, told Infectious Diseases in Children. “It is critically important that these fragile infants are born at facilities with the appropriate resources and know-how.”
Jochen Profit
A previous study showed greater mortality of very low-birth-weight infants in lower-level and lower-volume NICUs, Profit and colleagues. Further, a meta-analysis demonstrated a 62% greater risk for mortality outside high-level NICUs.
Between 2008 and 2012, the investigators performed a cross-sectional analysis of 21,051 very low-birth-weight infants at 134 California NICUs, which designated their level of care based on the 2012 AAP guidelines. The researchers analyzed quality of care by using Baby-MONITOR, an indicator that incorporates nine risk-adjusted measures.
The researchers observed a wide variation in scores and that the level of care was not associated with overall quality scores. According to subcomponent analysis, antenatal steroids (P = .002) and human milk feeding at discharge led to higher performance of Level IV NICUs, while pneumothorax (P < .001), growth velocity (P = .006) and health care associated infections (P = .04) resulted in lower performance. No other health system or organization factors were significantly associated with Baby-MONITOR scores.
“This study provides a good example for the usefulness of composite indicators,” Profit and colleagues wrote. “The composite provides a global picture of differences in quality of care and of the association with important predictors of quality.
“These findings highlight opportunities for further improvements that can be addressed through targeted interventions.” – by Will Offit
Disclosure: The researchers report no relevant financial disclosures.
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