Skip to main content

The Association of Level of Care With NICU Quality.

Publication ,  Journal Article
Profit, J; Gould, JB; Bennett, M; Goldstein, BA; Draper, D; Phibbs, CS; Lee, HC
Published in: Pediatrics
March 2016

BACKGROUND: Regionalized care delivery purportedly optimizes care to vulnerable very low birth weight (VLBW; <1500 g) infants. However, a comprehensive assessment of quality of care delivery across different levels of NICUs has not been done. METHODS: We conducted a cross-sectional analysis of 21,051 VLBW infants in 134 California NICUs. NICUs designated their level of care according to 2012 American Academy of Pediatrics guidelines. We assessed quality of care delivery via the Baby-MONITOR, a composite indicator, which combines 9 risk-adjusted measures of quality. Baby-MONITOR scores are measured as observed minus expected performance, expressed in standard units with a mean of 0 and an SD of 1. RESULTS: Wide variation in Baby-MONITOR scores exists across California (mean [SD] 0.18 (1.14), range -2.26 to 3.39). However, level of care was not associated with overall quality scores. Subcomponent analysis revealed trends for higher performance of Level IV NICUs on several process measures, including antenatal steroids and any human milk feeding at discharge, but lower scores for several outcomes including any health care associated infection, pneumothorax, and growth velocity. No other health system or organizational factors including hospital ownership, neonatologist coverage, urban or rural location, and hospital teaching status, were significantly associated with Baby-MONITOR scores. CONCLUSIONS: The comprehensive assessment of the effect of level of care on quality reveals differential opportunities for improvement and allows monitoring of efforts to ensure that fragile VLBW infants receive care in appropriate facilities.

Duke Scholars

Altmetric Attention Stats
Dimensions Citation Stats

Published In

Pediatrics

DOI

EISSN

1098-4275

Publication Date

March 2016

Volume

137

Issue

3

Start / End Page

e20144210

Location

United States

Related Subject Headings

  • Quality Indicators, Health Care
  • Pediatrics
  • Outcome Assessment, Health Care
  • Intensive Care Units, Neonatal
  • Infant, Very Low Birth Weight
  • Infant, Newborn
  • Humans
  • Cross-Sectional Studies
  • California
  • 52 Psychology
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Profit, J., Gould, J. B., Bennett, M., Goldstein, B. A., Draper, D., Phibbs, C. S., & Lee, H. C. (2016). The Association of Level of Care With NICU Quality. Pediatrics, 137(3), e20144210. https://doi.org/10.1542/peds.2014-4210
Profit, Jochen, Jeffrey B. Gould, Mihoko Bennett, Benjamin A. Goldstein, David Draper, Ciaran S. Phibbs, and Henry C. Lee. “The Association of Level of Care With NICU Quality.Pediatrics 137, no. 3 (March 2016): e20144210. https://doi.org/10.1542/peds.2014-4210.
Profit J, Gould JB, Bennett M, Goldstein BA, Draper D, Phibbs CS, et al. The Association of Level of Care With NICU Quality. Pediatrics. 2016 Mar;137(3):e20144210.
Profit, Jochen, et al. “The Association of Level of Care With NICU Quality.Pediatrics, vol. 137, no. 3, Mar. 2016, p. e20144210. Pubmed, doi:10.1542/peds.2014-4210.
Profit J, Gould JB, Bennett M, Goldstein BA, Draper D, Phibbs CS, Lee HC. The Association of Level of Care With NICU Quality. Pediatrics. 2016 Mar;137(3):e20144210.

Published In

Pediatrics

DOI

EISSN

1098-4275

Publication Date

March 2016

Volume

137

Issue

3

Start / End Page

e20144210

Location

United States

Related Subject Headings

  • Quality Indicators, Health Care
  • Pediatrics
  • Outcome Assessment, Health Care
  • Intensive Care Units, Neonatal
  • Infant, Very Low Birth Weight
  • Infant, Newborn
  • Humans
  • Cross-Sectional Studies
  • California
  • 52 Psychology