Perinatal Epidemiology and Health Outcomes Research Unit, Division of Neonatology, Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children's Hospital, Palo Alto, California; California Perinatal Quality Care Collaborative, Palo Alto, California;
Department of Biostatistics & Bioinformatics, Duke University, Durham, North Carolina; and.
Pediatrics. 2015 Feb;135(2):e397-404. doi: 10.1542/peds.2014-2177. Epub 2015 Jan 19.
Examination of regional care patterns in antenatal corticosteroid use (ACU) rates may be salient for the development of targeted interventions. Our objective was to assess network-level variation using California perinatal care regions as a proxy. We hypothesized that (1) significant variation in ACU exists within and between California perinatal care regions, and (2) lower performing regions exhibit greater NICU-level variability in ACU than higher performing regions.
We undertook cross-sectional analysis of 33,610 very low birth weight infants cared for at 120 hospitals in 11 California perinatal care regions from 2005 to 2011. We computed risk-adjusted median ACU rates and interquartile ranges (IQR) for each perinatal care region. The degree of variation was assessed using hierarchical multivariate regression analysis with NICU as a random effect and region as a fixed effect.
From 2005 to 2011, mean ACU rates across California increased from 82% to 87.9%. Regional median (IQR) ACU rates ranged from 68.4% (24.3) to 92.9% (4.8). We found significant variation in ACU rates among regions (P < .0001). Compared with Level IV NICUs, care in a lower level of care was a strongly significant predictor of lower odds of receiving antenatal corticosteroids in a multilevel model (Level III, 0.65 [0.45-0.95]; Level II, 0.39 [0.24-0.64]; P < .001). Regions with lower performance in ACU exhibited greater variability in performance.
We found significant variation in ACU rates among California perinatal regions. Regional quality improvement approaches may offer a new avenue to spread best practice.
检查产前皮质类固醇使用（ACU）率的区域性护理模式对于制定有针对性的干预措施可能很重要。我们的目的是使用加利福尼亚围产期护理区域作为代理来评估网络水平的变化。我们假设：（1）ACU 在加利福尼亚围产期护理区域内和之间存在显着差异；（2）表现较差的区域比表现较高的区域在 ACU 方面表现出更大的新生儿重症监护病房（NICU）水平的变异性。
我们对 2005 年至 2011 年间加利福尼亚州 11 个围产期护理区域的 120 家医院的 33610 名极低出生体重婴儿进行了横断面分析。我们为每个围产期护理区域计算了风险调整的中位数 ACU 率和四分位距（IQR）。使用包含 NICU 作为随机效应和区域作为固定效应的分层多变量回归分析评估了变化程度。
从 2005 年到 2011 年，加利福尼亚州的平均 ACU 率从 82%增加到 87.9%。区域中位数（IQR）ACU 率范围为 68.4%（24.3）至 92.9%（4.8）。我们发现区域之间的 ACU 率存在显着差异（P<.0001）。与 IV 级新生儿重症监护病房相比，在多层次模型中，在较低级别的护理中接受产前皮质类固醇的可能性较低（III 级，0.65[0.45-0.95]；II 级，0.39[0.24-0.64]；P<.001）。ACU 表现较低的区域表现出更大的表现变异性。
我们发现加利福尼亚围产期区域之间的 ACU 率存在显着差异。区域质量改进方法可能提供传播最佳实践的新途径。
