Departments of Epidemiology & Biostatistics and
Center for Surgical Outcomes Research, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio.
Pediatrics. 2017 Mar;139(3). doi: 10.1542/peds.2016-2364. Epub 2017 Feb 10.
To examine contributing factors and potential reasons for hospital differences in unexpected newborn complication rates in Florida.
We conducted a population-based retrospective cohort study of linked birth certificate and hospital discharge records from 2004 to 2013. The study population included 1 604 774 term, singleton live births in 124 hospitals. Severe and moderate complications were identified via a published algorithm. Logistic mixed-effects models were used to examine risk factors for complications and to estimate the percentage of hospital variation explained by factors. Descriptive analyses were performed to explore reasons for the differences.
Hospital total complication rates varied from 6.7 to 98.6 per 1000 births. No correlation between severe and moderate complication rates by hospital was identified. Leading risk factors for complications included medically indicated early-term delivery, no prenatal care, nulliparity, prepregnancy obesity, tobacco use, and delivery in southern Florida hospitals. Hospital factors such as geographic location, level of care or birth volume, and Medicaid births percentage explained 35% and 27.8% of variation in severe and moderate complication rates, respectively. Individual factors explained an additional 6% of variation in severe complication rates. Different complication subcategories (eg, infections, hospital transfers) drove the hospital factors that contributed to severe and moderate complications.
Variation in unexpected complication rates is more likely to be related to hospital rather than patient characteristics in Florida. The high proportion of variation explained by hospital factors suggests potential opportunities for improvement, and identifying specific complication categories may provide focus areas. Some of the opportunities may be related to differences in hospital coding practice.
研究佛罗里达州医院新生儿意外并发症发生率差异的影响因素和潜在原因。
我们开展了一项基于人群的回顾性队列研究，对 2004 年至 2013 年的出生证明和医院出院记录进行了关联分析。研究人群包括 124 家医院的 1 604 774 例足月单胎活产儿。严重和中度并发症是通过已发表的算法确定的。使用逻辑混合效应模型来研究并发症的危险因素，并估计由各因素解释的医院变异百分比。描述性分析用于探索差异的原因。
医院的总并发症发生率从 6.7 至 98.6 每 1000 例活产不等。医院间严重和中度并发症发生率之间没有相关性。并发症的主要危险因素包括医学指征的早产、无产前保健、初产妇、孕前肥胖、吸烟和在佛罗里达州南部医院分娩。医院因素，如地理位置、护理水平或分娩量、医疗补助分娩比例，分别解释了严重和中度并发症发生率变异的 35%和 27.8%。个体因素进一步解释了严重并发症发生率变异的 6%。不同的并发症亚类（如感染、医院转院）导致了与严重和中度并发症相关的医院因素。
佛罗里达州医院意外并发症发生率的差异更可能与医院而不是患者特征有关。医院因素解释的变异比例较高，这表明存在潜在的改进机会，确定特定的并发症类别可能为重点领域提供依据。一些机会可能与医院编码实践的差异有关。
