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Regional variation in antenatal corticosteroid use: a network-level quality improvement study.

Publication ,  Journal Article
Profit, J; Goldstein, BA; Tamaresis, J; Kan, P; Lee, HC
Published in: Pediatrics
February 2015

BACKGROUND AND OBJECTIVES: Examination of regional care patterns in antenatal corticosteroid use (ACU) rates may be salient for the development of targeted interventions. Our objective was to assess network-level variation using California perinatal care regions as a proxy. We hypothesized that (1) significant variation in ACU exists within and between California perinatal care regions, and (2) lower performing regions exhibit greater NICU-level variability in ACU than higher performing regions. METHODS: We undertook cross-sectional analysis of 33,610 very low birth weight infants cared for at 120 hospitals in 11 California perinatal care regions from 2005 to 2011. We computed risk-adjusted median ACU rates and interquartile ranges (IQR) for each perinatal care region. The degree of variation was assessed using hierarchical multivariate regression analysis with NICU as a random effect and region as a fixed effect. RESULTS: From 2005 to 2011, mean ACU rates across California increased from 82% to 87.9%. Regional median (IQR) ACU rates ranged from 68.4% (24.3) to 92.9% (4.8). We found significant variation in ACU rates among regions (P < .0001). Compared with Level IV NICUs, care in a lower level of care was a strongly significant predictor of lower odds of receiving antenatal corticosteroids in a multilevel model (Level III, 0.65 [0.45-0.95]; Level II, 0.39 [0.24-0.64]; P < .001). Regions with lower performance in ACU exhibited greater variability in performance. CONCLUSIONS: We found significant variation in ACU rates among California perinatal regions. Regional quality improvement approaches may offer a new avenue to spread best practice.

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Published In

Pediatrics

DOI

EISSN

1098-4275

Publication Date

February 2015

Volume

135

Issue

2

Start / End Page

e397 / e404

Location

United States

Related Subject Headings

  • Young Adult
  • Topography, Medical
  • Risk Factors
  • Respiratory Distress Syndrome, Newborn
  • Regional Medical Programs
  • Quality Improvement
  • Quality Assurance, Health Care
  • Prenatal Exposure Delayed Effects
  • Pregnancy
  • Pediatrics
 

Citation

APA
Chicago
ICMJE
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Profit, J., Goldstein, B. A., Tamaresis, J., Kan, P., & Lee, H. C. (2015). Regional variation in antenatal corticosteroid use: a network-level quality improvement study. Pediatrics, 135(2), e397–e404. https://doi.org/10.1542/peds.2014-2177
Profit, J., B. A. Goldstein, J. Tamaresis, P. Kan, and H. C. Lee. “Regional variation in antenatal corticosteroid use: a network-level quality improvement study.Pediatrics 135, no. 2 (February 2015): e397–404. https://doi.org/10.1542/peds.2014-2177.
Profit J, Goldstein BA, Tamaresis J, Kan P, Lee HC. Regional variation in antenatal corticosteroid use: a network-level quality improvement study. Pediatrics. 2015 Feb;135(2):e397–404.
Profit, J., et al. “Regional variation in antenatal corticosteroid use: a network-level quality improvement study.Pediatrics, vol. 135, no. 2, Feb. 2015, pp. e397–404. Pubmed, doi:10.1542/peds.2014-2177.
Profit J, Goldstein BA, Tamaresis J, Kan P, Lee HC. Regional variation in antenatal corticosteroid use: a network-level quality improvement study. Pediatrics. 2015 Feb;135(2):e397–e404.

Published In

Pediatrics

DOI

EISSN

1098-4275

Publication Date

February 2015

Volume

135

Issue

2

Start / End Page

e397 / e404

Location

United States

Related Subject Headings

  • Young Adult
  • Topography, Medical
  • Risk Factors
  • Respiratory Distress Syndrome, Newborn
  • Regional Medical Programs
  • Quality Improvement
  • Quality Assurance, Health Care
  • Prenatal Exposure Delayed Effects
  • Pregnancy
  • Pediatrics