Ekelem I, Taeusch H W
Department of Pediatrics, King/Drew Medical Center, Los Angeles, Calif. 90059.
J Natl Med Assoc. 1990 May;82(5):345-50.
Observed and birthweight-specific neonatal mortality rates have been used for assessing quality of neonatal care, but these are crude and affected by risk characteristics of the population served. Even when neonatal mortality rate is corrected for four risk factors, race, sex, birthweight, and multiple births, (California Data Research Facility, Santa Barbara, CA) it is possible that the corrected neonatal mortality rate is not comparable among institutions because of population differences not corrected for, eg, prenatal care. To analyze whether our high neonatal mortality rate is primarily dependent on population risk or quality of neonatal care, we used contemporaneous data collection by senior physicians and a microcomputer database system to construct indices of quality of care that are based on diagnoses graded according to disease severity. For the 1987/1988 academic year, we found: neonatal intensive care unit nosocomial infection rate, 20%; severe intraventricular hemorrhage per 100 very low birthweight infants (1500 g), 20%; bronchopulmonary dysplasia per 100 cases of severe respiratory distress syndrome, 27%; necrotizing enterocolitis per 100 neonatal intensive care unit discharges, 5%; air leak per 100 cases of severe respiratory distress syndrome, 21%; and neonatal mortality rate per very low birthweight delivery rate, 0.4. We propose that microcomputer, hospital-based analyses will improve comparisons of neonatal intensive care unit quality of care if appropriate indices can be sufficiently well-defined and shared.
观察到的新生儿死亡率和按出生体重划分的新生儿死亡率一直被用于评估新生儿护理质量，但这些都是粗略的指标，且受到所服务人群风险特征的影响。即使新生儿死亡率针对种族、性别、出生体重和多胞胎这四个风险因素进行了校正（加利福尼亚数据研究机构，加利福尼亚州圣巴巴拉），由于未校正的人群差异（例如产前护理），各机构之间校正后的新生儿死亡率仍可能不可比。为了分析我们较高的新生儿死亡率主要是取决于人群风险还是新生儿护理质量，我们通过资深医生同期收集数据，并使用微机数据库系统构建护理质量指标，这些指标基于根据疾病严重程度分级的诊断。对于1987/1988学年，我们发现：新生儿重症监护病房医院感染率为20%；每100例极低出生体重儿（1500克）中重度脑室内出血的发生率为20%；每100例严重呼吸窘迫综合征病例中支气管肺发育不良的发生率为27%；每100例新生儿重症监护病房出院病例中坏死性小肠结肠炎的发生率为5%；每100例严重呼吸窘迫综合征病例中气胸的发生率为21%；极低出生体重儿分娩率对应的新生儿死亡率为0.4。我们建议，如果能够充分明确并共享适当的指标，基于医院的微机分析将改善新生儿重症监护病房护理质量的比较。
