Bolbocean Corneliu, Shevell Michael
Department of Preventive Medicine, University of Tennessee Health Science Centre, 66 N. Pauline Street, Memphis, TN, 38163, USA.
The Centre for Addiction and Mental Health, Toronto, Ontario, 33 Russell St, Toronto, ON, M5S 2S1, Canada.
Health Econ Rev. 2020 Jul 8;10(1):22. doi: 10.1186/s13561-020-00279-8.
An equitable and affordable healthcare system requires a constant search for the optimal way to deliver increasingly expensive neonatal care. Therefore, evaluating the impact of hospital intensity around birth on long-term health outcomes is necessary if we are to assess the value of high intensity neonatal care against its costs.
This study exploits uneven geographical distribution of high intensity birth hospitals across Canada to generate comparisons across similar Cerebral Palsy (CP) related births treated at hospitals with different intensities. We employ a rich dataset from the Canadian Multi-Regional CP Registry (CCPR) and instrumental variables related to the mother's location of residence around birth.
We find that differences in hospitals' intensities are not associated with differences in clinically relevant, long-term CP health outcomes.
Our results suggest that existing matching mechanism of births to hospitals within large metropolitan areas could be improved by early detection of high risk births and subsequent referral of these births to high intensity birthing centers. Substantial hospitalization costs might be averted to Canadian healthcare system ($16 million with a 95% CI of $6,131,184 - $24,103,478) if CP related births were assigned to low intensity hospitals and subsequently transferred if necessary to high intensity hospitals.
一个公平且负担得起的医疗保健系统需要不断探寻提供日益昂贵的新生儿护理的最佳方式。因此，如果我们要评估高强度新生儿护理的价值与其成本的关系，那么评估出生前后医院护理强度对长期健康结果的影响是必要的。
本研究利用加拿大高强度分娩医院地理分布不均的情况，对在不同强度医院接受治疗的类似脑瘫（CP）相关出生病例进行比较。我们使用了来自加拿大多地区脑瘫登记处（CCPR）的丰富数据集以及与母亲出生时居住地点相关的工具变量。
我们发现医院护理强度的差异与临床相关的长期脑瘫健康结果的差异无关。
我们的结果表明，通过早期发现高危出生病例并随后将这些病例转诊至高强度分娩中心，可以改善大城市地区内现有出生病例与医院的匹配机制。如果将与脑瘫相关的出生病例分配到低强度医院，并在必要时随后转至高强度医院，加拿大医疗保健系统可能避免大量住院费用（1600万美元，95%置信区间为6131184美元至24103478美元）。
