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Accounting for variation in length of NICU stay for extremely low birth weight infants.

Lee HC, Bennett MV, Schulman J, Gould JB - J Perinatol (2013)

Bottom Line: LOS was defined as days from admission to discharge.Lower birth weight, lack of antenatal steroids and lower Apgar score were associated with longer LOS.There was negligible correlation between risk-adjusted LOS and hospital mortality rates (r=0.0207) and transfer-out rates (r=0.121).

View Article: PubMed Central - PubMed

Affiliation: 1] Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University, Stanford, CA, USA [2] California Perinatal Quality Care Collaborative, Palo Alto, CA, USA.

ABSTRACT

Objective: To develop a length of stay (LOS) model for extremely low birth weight (ELBW) infants.

Study design: We included infants from the California Perinatal Quality Care Collaborative with birth weight 401 to 1000 g who were discharged to home. Exclusion criteria were congenital anomalies, surgery and death. LOS was defined as days from admission to discharge. As patients who died or were transferred to lower level of care were excluded, we assessed correlation of hospital mortality rates and transfers to risk-adjusted LOS.

Results: There were 2012 infants with median LOS 79 days (range 23 to 219). Lower birth weight, lack of antenatal steroids and lower Apgar score were associated with longer LOS. There was negligible correlation between risk-adjusted LOS and hospital mortality rates (r=0.0207) and transfer-out rates (r=0.121).

Conclusion: Particularly because ELBW infants have extended hospital stays, identification of unbiased and informative risk-adjusted LOS for these infants is an important step in benchmarking best practice and improving efficiency in care.

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Related in: MedlinePlus

Mortality observed to expected ratio and risk adjusted length of stay – CPQCC Member Hospitals.Weighted regression – each dot represents one hospital and is assigned a weight of number of eligible infants. Hospitals with greater than 20 eligible patients are noted with a dark circle; hospitals with 20 or less patients are noted with an open circle. Slope =0.00351, R = 0.0207, R2 =0.0004, p=0.829
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Figure 2: Mortality observed to expected ratio and risk adjusted length of stay – CPQCC Member Hospitals.Weighted regression – each dot represents one hospital and is assigned a weight of number of eligible infants. Hospitals with greater than 20 eligible patients are noted with a dark circle; hospitals with 20 or less patients are noted with an open circle. Slope =0.00351, R = 0.0207, R2 =0.0004, p=0.829

Mentions: In order to assess the possibility of bias for NICUs that had higher mortality rates leading to shorter LOS, we investigated the relationship between risk-adjusted mortality to the mean risk-adjusted LOS in hospitals (Figure 2). The mean mortality rate at the NICU level was 15.3% with interquartile range: 8.7% to 22.4% (risk adjusted mortality rate mean 16.0%, interquartile range 9.9% to 23.5%). The regression fit between LOS and risk adjusted mortality rate was poor with a slope of 0.00351and R = 0.0207, indicating no relationship between mortality rate and length of stay by NICU.


Accounting for variation in length of NICU stay for extremely low birth weight infants.

Lee HC, Bennett MV, Schulman J, Gould JB - J Perinatol (2013)

Mortality observed to expected ratio and risk adjusted length of stay – CPQCC Member Hospitals.Weighted regression – each dot represents one hospital and is assigned a weight of number of eligible infants. Hospitals with greater than 20 eligible patients are noted with a dark circle; hospitals with 20 or less patients are noted with an open circle. Slope =0.00351, R = 0.0207, R2 =0.0004, p=0.829
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Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3815522&req=5

Figure 2: Mortality observed to expected ratio and risk adjusted length of stay – CPQCC Member Hospitals.Weighted regression – each dot represents one hospital and is assigned a weight of number of eligible infants. Hospitals with greater than 20 eligible patients are noted with a dark circle; hospitals with 20 or less patients are noted with an open circle. Slope =0.00351, R = 0.0207, R2 =0.0004, p=0.829
Mentions: In order to assess the possibility of bias for NICUs that had higher mortality rates leading to shorter LOS, we investigated the relationship between risk-adjusted mortality to the mean risk-adjusted LOS in hospitals (Figure 2). The mean mortality rate at the NICU level was 15.3% with interquartile range: 8.7% to 22.4% (risk adjusted mortality rate mean 16.0%, interquartile range 9.9% to 23.5%). The regression fit between LOS and risk adjusted mortality rate was poor with a slope of 0.00351and R = 0.0207, indicating no relationship between mortality rate and length of stay by NICU.

Bottom Line: LOS was defined as days from admission to discharge.Lower birth weight, lack of antenatal steroids and lower Apgar score were associated with longer LOS.There was negligible correlation between risk-adjusted LOS and hospital mortality rates (r=0.0207) and transfer-out rates (r=0.121).

View Article: PubMed Central - PubMed

Affiliation: 1] Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University, Stanford, CA, USA [2] California Perinatal Quality Care Collaborative, Palo Alto, CA, USA.

ABSTRACT

Objective: To develop a length of stay (LOS) model for extremely low birth weight (ELBW) infants.

Study design: We included infants from the California Perinatal Quality Care Collaborative with birth weight 401 to 1000 g who were discharged to home. Exclusion criteria were congenital anomalies, surgery and death. LOS was defined as days from admission to discharge. As patients who died or were transferred to lower level of care were excluded, we assessed correlation of hospital mortality rates and transfers to risk-adjusted LOS.

Results: There were 2012 infants with median LOS 79 days (range 23 to 219). Lower birth weight, lack of antenatal steroids and lower Apgar score were associated with longer LOS. There was negligible correlation between risk-adjusted LOS and hospital mortality rates (r=0.0207) and transfer-out rates (r=0.121).

Conclusion: Particularly because ELBW infants have extended hospital stays, identification of unbiased and informative risk-adjusted LOS for these infants is an important step in benchmarking best practice and improving efficiency in care.

Show MeSH
Related in: MedlinePlus