Ounpraseuth Songthip, Bronstein Janet, Gauss C Heath, Wingate Martha S, Hall Richard W, Nugent Richard R
Department of Biostatistics, College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama.
Am J Perinatol. 2015 Jan;32(1):33-42. doi: 10.1055/s-0034-1373843. Epub 2014 May 2.
The objective of this study was to examine the time trend in length of stay (LOS) and explore potential differences in neonatal LOS by insurance type for preterm infants in Arkansas between 2004 and 2010.
There were 18,712 preterm infants included in our analyses. Accelerated failure time models were used to model neonatal LOS as a function of insurance type and discharge year while adjusting for key maternal and infant characteristics, and complication/anomaly indicators.
Before adjusting for the complication/anomaly indicators, the LOS for preterm infants delivered to mothers in the Medicaid group was 3.2% shorter than those in the private payer group. Furthermore, each subsequent year was associated with a 1.6% increase in the expected LOS. However, after accounting for complications and anomalies, insurance coverage differences in neonatal LOS were not statistically significant while the trend in LOS persisted at a 0.59% increase for each succeeding year.
All of the apparent differences in LOS by insurance type and more than half of the apparent increase in LOS over time are accounted for by higher rates of complications among privately insured preterm infants and increasing rates of complications for all surviving preterm infants between 2004 and 2010.
本研究的目的是调查住院时间（LOS）的时间趋势，并探讨2004年至2010年阿肯色州早产婴儿按保险类型划分的新生儿住院时间的潜在差异。
我们的分析纳入了18712名早产婴儿。使用加速失效时间模型将新生儿住院时间建模为保险类型和出院年份的函数，同时调整关键的母婴特征以及并发症/异常指标。
在调整并发症/异常指标之前，医疗补助组母亲所生早产婴儿的住院时间比私人支付者组的短3.2%。此外，随后的每一年预期住院时间增加1.6%。然而，在考虑并发症和异常情况后，新生儿住院时间的保险覆盖差异无统计学意义，而住院时间的趋势持续存在，每连续一年增加0.59%。
按保险类型划分的住院时间的所有明显差异以及随着时间推移住院时间明显增加的一半以上，是由2004年至2010年期间私人保险早产婴儿的较高并发症发生率以及所有存活早产婴儿不断增加的并发症发生率所导致的。
