Department of Health Management and Policy, University of Iowa, E205 GH, 200 Hawkins Drive, Iowa City, IA 52242, USA.
Health Serv Res. 2012 Aug;47(4):1502-21. doi: 10.1111/j.1475-6773.2012.01383.x. Epub 2012 Feb 21.
To assess the effects of hospital volume of very low-birthweight (VLBW) infants on in-hospital mortality of VLBW and very preterm birth (VPB) infants in South America.
DATA SOURCES/STUDY SETTING: Birth-registry data for infants born in 1982-2008 at VLBW or very preterm in 66 hospitals in Argentina, Brazil, and Chile.
Regression analyses that adjust for several individual-level demographic, socioeconomic, and health factors; hospital-level characteristics; and country-fixed effects are employed.
DATA COLLECTION/EXTRACTION METHODS: Physicians interviewed mothers before hospital discharge and abstracted hospital medical records using similar methods at all hospitals.
Volume has significant nonlinear beneficial effects on VLBW and VPB in-hospital survival. The largest survival benefits--more than 80 percent decrease in mortality rates--are with volume increases from low to medium or medium-high levels (from ≤ 25 to 72 infants annually) with significantly lower incremental benefits thereafter. The cumulative volume effects are maximized at the 121-144 annual VLBW infant range--about 90 percent decrease in mortality rates compared to <25 VLBW infants annually.
Increasing the access of pregnancies at-risk of VLBW and VPB to medium- or high-volume hospitals up to 144 VLBW infants per year may substantially improve in-hospital infant survival in the study countries.
评估南美极低出生体重儿（VLBW）和极早产儿（VPB）的医院容量对住院死亡率的影响。
资料来源/研究场所：1982 年至 2008 年在阿根廷、巴西和智利的 66 家医院出生的 VLBW 或极早产儿的出生登记数据。
采用回归分析，调整了几个个体水平的人口统计学、社会经济和健康因素、医院水平的特征以及国家固定效应。
资料收集/提取方法：医生在出院前对母亲进行访谈，并在所有医院使用类似的方法对医院的医疗记录进行摘录。
容量对 VLBW 和 VPB 的住院生存率有显著的非线性有益影响。最大的生存获益是从低到中或中高水平（从每年≤25 到 72 名婴儿）的容量增加，此后的增量获益显著降低。累积容量效应在每年 121-144 名 VLBW 婴儿的范围内达到最大值，与每年接受治疗的<25 名 VLBW 婴儿相比，死亡率降低了约 90%。
将有 VLBW 和 VPB 风险的妊娠产妇获得中等或高容量医院的机会增加到每年 144 名 VLBW 婴儿，可能会显著提高研究国家的住院婴儿生存率。
