Center for Health Outcomes and Policy Research, School of Nursing and
Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania.
Hosp Pediatr. 2021 Apr;11(4):342-349. doi: 10.1542/hpeds.2020-003145. Epub 2021 Mar 18.
To determine the extent to which newborns with neonatal abstinence syndrome (NAS) are concentrated in some hospitals as compared with newborns without NAS and whether care quality and safety differed among these hospitals. We hypothesized that newborns with NAS would be cared for in poorer-quality hospitals.
Secondary analysis of 3 2016 data sets: (1) the panel study of effects of changes in nursing on patient outcomes-US survey of hospital registered nurses regarding work conditions and safety, (2) inpatient discharge abstracts, and (3) the American Hospital Association annual survey. Newborns in 266 hospitals from the 4 states where the panel study of effects of changes in nursing on patient outcomes was conducted were included. We used Lorenz curves to determine if newborns with NAS were concentrated in different hospitals than newborns without NAS and whether care quality and safety differed among those hospitals. Quality and safety were assessed by staff nurses by using standard survey questions.
Of the 659 403 newborns in this study, 3130 were diagnosed with noniatrogenic NAS. We found that newborns with NAS were cared for in different hospitals compared with newborns without NAS (Gini coefficient 0.62, 95% confidence interval, 0.56-0.68) and that the hospitals in which they received care were rated as having poorer quality and safety (Gini coefficient 0.12, 95% confidence interval, 0.01-0.23).
Newborns with NAS are cared for in poorer-quality hospitals than other newborns. Our findings are of concern because poorer-quality care is linked to patient outcomes. As stakeholders seek to address the opioid epidemic and improve outcomes of newborns with NAS, our findings suggest the importance of examining hospital factors.
确定患有新生儿戒断综合征（NAS）的新生儿与无 NAS 的新生儿相比在哪些医院更为集中，以及这些医院的护理质量和安全性是否存在差异。我们假设患有 NAS 的新生儿将在护理质量较差的医院接受治疗。
对 2016 年的 3 个数据集进行二次分析：（1）护士对患者结局影响变化的面板研究——对医院注册护士的工作条件和安全的美国调查；（2）住院病人出院摘要；（3）美国医院协会年度调查。纳入了在进行护士对患者结局影响变化的面板研究的 4 个州的 266 家医院的新生儿。我们使用洛伦兹曲线来确定患有 NAS 的新生儿是否集中在与无 NAS 的新生儿不同的医院，以及这些医院的护理质量和安全性是否存在差异。护理质量和安全性由护士使用标准调查问题进行评估。
在这项研究的 659403 名新生儿中，有 3130 名被诊断为非医源性 NAS。我们发现，患有 NAS 的新生儿在接受治疗的医院与没有 NAS 的新生儿不同（基尼系数为 0.62，95%置信区间为 0.56-0.68），并且他们接受治疗的医院被评为护理质量和安全性较差（基尼系数为 0.12，95%置信区间为 0.01-0.23）。
患有 NAS 的新生儿在护理质量较差的医院接受治疗，而不是其他新生儿。我们的研究结果令人担忧，因为较差的护理质量与患者的预后有关。由于利益相关者正在寻求解决阿片类药物流行问题并改善患有 NAS 的新生儿的预后，我们的研究结果表明，检查医院因素的重要性。
