Department of Obstetrics and Gynecology, University of California, Orange, CA 92868, USA.
J Perinatol. 2011 Dec;31(12):770-5. doi: 10.1038/jp.2011.29. Epub 2011 Apr 14.
The objective of this study was to examine the effect of hospital-level factors on mortality of very low birth weight infants using multilevel modeling.
This is a secondary data analysis of California maternal-infant hospital discharge data from 1997 to 2002. The study population was limited to singleton, non-anomalous, very low birth weight infants, who delivered in hospitals providing neonatal intensive care services (level-2 and higher). Hierarchical generalized linear modeling, also known as multilevel modeling, was used to adjust for individual-level confounders.
In a multilevel model, increasing hospital volume of very low birth weight deliveries was associated with lower odds of very low birth weight mortality. Characteristics of a particular hospital's obstetrical and neonatal services (the presence of residency and fellowship training programs and the availability of perinatal and neonatal services) had no independent effect.
Using multilevel modeling, hospital volume of very low birth weight deliveries appears to be the primary driver of reduced mortality among very low birth weight infants.
本研究旨在通过多水平模型探讨医院水平因素对极低出生体重儿死亡率的影响。
这是对 1997 年至 2002 年加利福尼亚母婴医院出院数据的二次数据分析。研究人群仅限于在提供新生儿重症监护服务的医院（2 级及以上）分娩的单胎、非异常、极低出生体重儿。分层广义线性模型，也称为多水平模型，用于调整个体水平的混杂因素。
在多水平模型中，极低出生体重儿分娩量的增加与极低出生体重儿死亡率的降低呈负相关。特定医院产科和新生儿科服务的特征（住院医师和研究员培训项目的存在以及围产期和新生儿科服务的可用性）没有独立影响。
使用多水平模型，极低出生体重儿分娩量似乎是降低极低出生体重儿死亡率的主要驱动因素。
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