Goldstein Gregory P, Kan Peiyi, Phibbs Ciaran S, Main Elliott, Shaw Gary M, Lee Henry C
Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA.
Health Economics Resource Center and Center for Implementation to Innovation, Veterans Affairs Palo Alto Healthcare System, Menlo Park, CA, USA.
J Perinatol. 2022 Dec;42(12):1686-1694. doi: 10.1038/s41372-022-01505-3. Epub 2022 Sep 14.
Given that regionalization of extremely preterm births (EPTBs) is associated with improved infant outcomes, we assessed between-hospital variation in EPTB stratified by hospital level of neonatal care, and determined the proportion of variance explained by differences in maternal and hospital factors.
We assessed 7,046,253 births in California from 1997 to 2011, using hospital discharge, birth, and death certificate data. We estimated the association between maternal and hospital factors and EPTB using multivariable regression, calculated hospital-specific EPTB frequencies, and estimated between-hospital variances and median odds ratios, stratified by hospital level of care.
Hospital frequencies of EPTB ranged from 0% to 2.5%. Between-hospital EPTB frequencies varied substantially, despite stratifying by hospital level of care and accounting for confounding factors.
Our results demonstrate differences in EPTBs among hospitals with level 1 and 2 neonatal care, an area to target for future research and quality improvement.
鉴于极早产（EPTB）的区域化与改善婴儿结局相关，我们评估了按新生儿护理医院级别分层的EPTB在不同医院之间的差异，并确定了由母亲和医院因素差异所解释的方差比例。
我们利用医院出院、出生和死亡证明数据，评估了1997年至2011年加利福尼亚州的7,046,253例分娩。我们使用多变量回归估计母亲和医院因素与EPTB之间的关联，计算特定医院的EPTB频率，并按医院护理级别分层估计医院间方差和中位数优势比。
EPTB的医院频率范围为0%至2.5%。尽管按医院护理级别分层并考虑了混杂因素，但医院间EPTB频率仍有很大差异。
我们的结果表明，在一级和二级新生儿护理医院中，EPTB存在差异，这是未来研究和质量改进的一个目标领域。
