加利福尼亚极低出生体重儿的护理质量、结局和成本。
Quality, outcome, and cost of care provided to very low birth weight infants in California.
机构信息
Division of Neonatology, Department of Pediatrics, Oregon Health and Science University, Portland, OR, 97239, USA.
Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University, Stanford, CA, 94305, USA.
出版信息
J Perinatol. 2024 Feb;44(2):224-230. doi: 10.1038/s41372-023-01792-4. Epub 2023 Oct 7.
OBJECTIVE
To examine association of costs with quality of care and patient outcome across hospitals in California.
METHODS
Retrospective study of very low birth weight (VLBW) births from 2014-2018 linking birth certificate, hospital discharge records and clinical data. Quality was measured using the Baby-MONITOR score. Clinical outcome was measured using survival without major morbidity (SWMM). Hierarchical generalized linear models, adjusting for clinical factors, were used to estimate risk-adjusted measures of costs, quality, and outcome for each hospital. Association between these measures was evaluated using Pearson correlation coefficient.
RESULTS
In total, 15,415 infants from 104 NICUs were included. Risk-adjusted Baby-MONITOR score, SWMM rate, and costs varied substantially. There was no correlation between risk-adjusted cost and Baby-MONITOR score (r = 0, p = 0.998). Correlation between risk-adjusted cost and SWMM rate was inverse and not significant (r = -0.07, p = 0.48).
CONCLUSIONS
With the metrics used, we found no correlation between cost, quality, and outcomes in the care of VLBW infants.
目的
考察加利福尼亚州各医院的医疗成本与护理质量和患者预后之间的关系。
方法
对 2014 年至 2018 年出生的极低出生体重（VLBW）婴儿进行回顾性研究，将出生证明、医院出院记录和临床数据联系起来。使用婴儿监护评分（Baby-MONITOR score）来衡量质量。使用无重大发病率生存（SWMM）来衡量临床结果。使用分层广义线性模型，根据临床因素进行调整，对每家医院的风险调整后的成本、质量和结果进行估计。使用 Pearson 相关系数评估这些措施之间的相关性。
结果
共纳入 104 家新生儿重症监护病房的 15415 名婴儿。风险调整后的 Baby-MONITOR 评分、SWMM 率和成本差异很大。风险调整后的成本与 Baby-MONITOR 评分之间没有相关性（r=0，p=0.998）。风险调整后的成本与 SWMM 率之间的相关性呈负相关，但无统计学意义（r=-0.07，p=0.48）。
结论
根据使用的指标，我们发现极低出生体重儿护理的成本、质量和结果之间没有相关性。
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