Rogowski Jeannette A, Greenberg Lucy, Edwards Erika M, Ehret Danielle E Y, Buzas Jeffrey S, Horbar Jeffrey D
College of Health and Human Development, The Pennsylvania State University, University Park.
Vermont Oxford Network, Burlington.
JAMA Netw Open. 2025 Jun 2;8(6):e2513274. doi: 10.1001/jamanetworkopen.2025.13274.
As a result of consolidation in the health care delivery system, most very preterm infants in the US are born and receive care in multihospital health systems. The extent of variation in patient outcomes and length of stay for this vulnerable population across health systems and across hospitals within systems is not known.
To evaluate the extent of variation in mortality and length of stay within and across health systems for infants born very preterm (gestational age 24-29 weeks).
DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study examined data contributed by Vermont Oxford Network US member hospitals in 224 health systems that delivered care to very preterm infants born between January 1, 2021, and December 31, 2022.
Receipt of neonatal intensive care unit (NICU) care in a horizontally integrated multihospital health system.
Mortality rates and length of stay among surviving infants were estimated using multilevel logistic and linear models.
The sample included 38 501 infants (median [IQR] gestational age, 27 [26-28] weeks; 52.8% boys). The median (IQR) number of infants receiving care at a hospital system during the 2-year period was 108 (59-198); 91.0% were born at the reporting hospital, and 95.4% were born in the reporting system. The mean adjusted mortality rate in the highest performing quartile of systems was 7.8% (95% credible interval [CrI], 7.3%-8.3%) compared with 9.8% (95% CrI, 9.1%-10.7%) for the lowest performing quartile. The mean adjusted length of stay for surviving infants ranged from 78 days (95% CrI, 77-79 days) to 90 days (95% CrI, 88-91 days) between the highest and lowest performing quartiles of systems, respectively.
In this cross-sectional study of very preterm infants, there was a 2-percentage point difference in mortality between systems in the highest and lowest performing quartiles and a 12-day difference in mean length of stay among surviving infants, which are potentially clinically meaningful. Opportunities exist for health systems to improve quality at the health system level to decrease mortality among infants born very preterm and reduce resources used in patient care.
由于医疗保健提供系统的整合，美国大多数极早产儿在多医院医疗系统中出生并接受治疗。目前尚不清楚该脆弱人群在不同医疗系统以及系统内不同医院之间的患者结局和住院时间的差异程度。
评估极早产儿（胎龄24 - 29周）在医疗系统内部以及不同医疗系统之间的死亡率和住院时间差异程度。
设计、设置和参与者：这项横断面研究检查了佛蒙特牛津网络美国成员医院在2021年1月1日至2022年12月31日期间为极早产儿提供护理的224个医疗系统所提供的数据。
在横向整合的多医院医疗系统中接受新生儿重症监护病房（NICU）护理。
使用多级逻辑和线性模型估计存活婴儿的死亡率和住院时间。
样本包括38501名婴儿（中位[四分位间距]胎龄，27[26 - 28]周；52.8%为男孩）。在两年期间，每个医院系统接受护理的婴儿数量中位数（四分位间距）为108（59 - 198）；91.0%在报告医院出生，95.4%在报告系统出生。表现最佳的四分位系统中，调整后的平均死亡率为7.8%（95%可信区间[CrI]，7.3% - 8.3%），而表现最差的四分位系统为9.8%（95% CrI，9.1% - 10.7%）。在表现最佳和最差的四分位系统之间，存活婴儿的平均调整住院时间分别为78天（95% CrI，77 - 79天）至90天（95% CrI，88 - 91天）。
在这项关于极早产儿的横断面研究中，表现最佳和最差的四分位系统之间死亡率相差2个百分点，存活婴儿的平均住院时间相差12天，这可能具有临床意义。医疗系统有机会在系统层面提高质量，以降低极早产儿的死亡率并减少患者护理中使用的资源。
