医院中根据诊断严重程度和类别对新生儿重症监护病房入院人数的差异。

Hospital variation in admissions to neonatal intensive care units by diagnosis severity and category.

机构信息

Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA.

Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT, USA.

出版信息

J Perinatol. 2021 Mar;41(3):468-477. doi: 10.1038/s41372-020-00775-z. Epub 2020 Aug 14.

DOI:10.1038/s41372-020-00775-z

PMID:32801351

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7427695/

Abstract

OBJECTIVE

To examine interhospital variation in admissions to neonatal intensive care units (NICU) and reasons for the variation.

STUDY DESIGN

2010-2012 linked birth certificate and hospital discharge data from 35 hospitals in California on live births at 35-42 weeks gestation and ≥1500 g birth weight were used. Hospital variation in NICU admission rates was assessed by coefficient of variation. Patient/hospital characteristics associated with NICU admissions were identified by multivariable regression.

RESULTS

Among 276,489 newborns, 6.3% were admitted to NICU with 34.5% of them having mild diagnoses. There was high interhospital variation in overall risk-adjusted rate of NICU admission (coefficient of variation = 26.2) and NICU admission rates for mild diagnoses (coefficient of variation: 46.4-74.0), but lower variation for moderate/severe diagnoses (coefficient of variation: 8.8-14.1). Births at hospitals with more NICU beds had a higher likelihood of NICU admission.

CONCLUSION

Interhospital variation in NICU admissions is mostly driven by admissions for mild diagnoses, suggesting potential overuse.

摘要

目的

考察新生儿重症监护病房（NICU）入院的医院间差异及其原因。

研究设计

利用 2010-2012 年加利福尼亚州 35 家医院的出生证明和住院数据，对妊娠 35-42 周且出生体重≥1500 克的活产儿进行了分析。通过变异系数评估 NICU 入院率的医院间差异。通过多变量回归确定与 NICU 入院相关的患者/医院特征。

结果

在 276489 名新生儿中，有 6.3%的新生儿被收入 NICU，其中 34.5%的新生儿患有轻度疾病。整体风险调整后的 NICU 入院率（变异系数为 26.2）和轻度疾病 NICU 入院率（变异系数为 46.4-74.0）存在高度医院间差异，但中度/重度疾病的入院率差异较小（变异系数为 8.8-14.1）。NICU 床位较多的医院出生的新生儿更有可能被收入 NICU。