出生证明数据在评估新生儿重症监护病房入院医院间差异中的作用。

Utility of Birth Certificate Data for Evaluating Hospital Variation in Admissions to NICUs.

机构信息

Neonatal-Perinatal Medicine Fellowship Program, Maternal and Child Health Research Institute, and

Department of Pediatrics, Stanford Medicine, Stanford University, Stanford, California; and.

出版信息

Hosp Pediatr. 2020 Feb;10(2):190-194. doi: 10.1542/hpeds.2019-0116.

DOI:10.1542/hpeds.2019-0116

PMID:32005648

Abstract

OBJECTIVES

Efforts to study potential overuse of NICU admissions and hospital variation in practice are often hindered by a lack of an appropriate data source. We examined the concordance of hospital-level NICU admission rates between birth certificate data and California Children's Services (CCS) data to inform the utility of birth certificate data in studying hospital variation in NICU admissions.

METHODS

We analyzed birth certificate data from California in 2012 and hospital-specific summary data from CCS regarding NICU admissions. NICU admission rates were calculated for both data sets while using CCS data as the gold standard. The difference between birth certificate-based and CCS-based NICU admission rates was assessed by using the Wilcoxon signed rank test, and concordance between the 2 rates was evaluated by using Lin's concordance correlation coefficient and Kendall's W concordance coefficient.

RESULTS

Among a total of 103 hospitals that were linked between the 2 data sets, birth certificate data generally underreported NICU admission rates compared with CCS data (median = 7.72% vs 11.51%; < .001). However, in a subset of 35 hospitals where the difference in NICU admission rates between the 2 data sets was small, the birth certificate-based NICU admission rate showed good concordance with the rate from CCS data (Lin's concordance correlation coefficient = 0.91; 95% confidence interval: 0.84-0.95; Kendall's W concordance coefficient = 0.99; < .001). Hospitals with good-concordance data did not differ from other hospitals in the institutional characteristics assessed.

CONCLUSIONS

For a selected subset of hospitals, birth certificate data may offer a reasonable means to investigate hospital variation in NICU admissions.

摘要

目的

由于缺乏合适的数据源，研究新生儿重症监护病房（NICU）入院人数潜在过度使用和医院间实践差异的工作往往受到阻碍。我们检查了出生证明数据和加利福尼亚儿童服务（CCS）数据之间医院级别 NICU 入院率的一致性，以了解出生证明数据在研究 NICU 入院医院间差异方面的效用。

方法

我们分析了 2012 年加利福尼亚州的出生证明数据和 CCS 关于 NICU 入院的特定医院汇总数据。在使用 CCS 数据作为金标准的情况下，为两个数据集计算了 NICU 入院率。使用 Wilcoxon 符号秩检验评估了基于出生证明的和基于 CCS 的 NICU 入院率之间的差异，使用 Lin 的一致性相关系数和 Kendall 的 W 一致性系数评估了两种比率之间的一致性。

结果

在总共 103 家可以在两个数据集之间建立关联的医院中，出生证明数据通常比 CCS 数据报告的 NICU 入院率低（中位数=7.72%比 11.51%；<0.001）。然而，在两个数据集之间 NICU 入院率差异较小的 35 家医院中，基于出生证明的 NICU 入院率与 CCS 数据的入院率具有良好的一致性（Lin 的一致性相关系数=0.91；95%置信区间：0.84-0.95；Kendall 的 W 一致性系数=0.99；<0.001）。具有良好一致性数据的医院在评估的机构特征方面与其他医院没有区别。