Seaton Sarah E, Barker Lisa, Draper Elizabeth S, Abrams Keith R, Modi Neena, Manktelow Bradley N
Department of Health Sciences, University of Leicester, Leicester, United Kingdom.
Leicester Neonatal Unit, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom.
PLoS One. 2016 Oct 20;11(10):e0165202. doi: 10.1371/journal.pone.0165202. eCollection 2016.
Modelling length of stay in neonatal care is vital to inform service planning and the counselling of parents. Preterm babies, at the highest risk of mortality, can have long stays in neonatal care and require high resource use. Previous work has incorporated babies that die into length of stay estimates, but this still overlooks the levels of care required during their stay. This work incorporates all babies, and the levels of care they require, into length of stay estimates. Data were obtained from the National Neonatal Research Database for singleton babies born at 24-31 weeks gestational age discharged from a neonatal unit in England from 2011 to 2014. A Cox multistate model, adjusted for gestational age, was used to consider a baby's two competing outcomes: death or discharge from neonatal care, whilst also considering the different levels of care required: intensive care; high dependency care and special care. The probabilities of receiving each of the levels of care, or having died or been discharged from neonatal care are presented graphically overall and adjusted for gestational age. Stacked predicted probabilities produced for each week of gestational age provide a useful tool for clinicians when counselling parents about length of stay and for commissioners when considering allocation of resources. Multistate modelling provides a useful method for describing the entire neonatal care pathway, where rates of in-unit mortality can be high. For a healthcare service focussed on costs, it is important to consider all babies that contribute towards workload, and the levels of care they require.
对新生儿护理住院时长进行建模对于指导服务规划和向家长提供咨询至关重要。早产婴儿死亡风险最高，可能在新生儿护理中住院时间较长，且需要大量资源。以往的研究将死亡婴儿纳入了住院时长估计，但这仍忽略了他们住院期间所需的护理水平。本研究将所有婴儿及其所需的护理水平纳入了住院时长估计。数据取自2011年至2014年从英格兰一家新生儿病房出院的孕24 - 31周单胎婴儿的国家新生儿研究数据库。使用经胎龄调整的Cox多状态模型来考虑婴儿的两种竞争结局：死亡或从新生儿护理中出院，同时还考虑所需的不同护理水平：重症监护；高依赖护理和特殊护理。总体上以图形方式呈现接受每种护理水平、或已从新生儿护理中死亡或出院的概率，并经胎龄调整。为每个孕周生成的堆叠预测概率为临床医生在向家长咨询住院时长时以及为决策者在考虑资源分配时提供了一个有用的工具。多状态建模为描述整个新生儿护理路径提供了一种有用的方法，在该路径中单位内死亡率可能很高。对于注重成本的医疗服务而言，考虑所有对工作量有贡献的婴儿及其所需的护理水平很重要。
