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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

Rate of transfer-out 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 =0.365, R = 0.121, R2 = 0.0146, p=0.207
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Figure 3: Rate of transfer-out 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 =0.365, R = 0.121, R2 = 0.0146, p=0.207

Mentions: As our study included only infants who were discharged home, another potential bias that we considered was that hospitals that transferred more infants to lower levels of care for feeding and growing may have higher LOS. The average transfer-out rate for growth and discharge planning was 7.5% overall for ELBW infants, with range between 0 to 31%. The mean adjusted LOS for NICUs with transfer out rate < 10% (n=96 NICUs) was 80.7 days (interquartile range 79.1 – 83.0) while the mean adjusted LOS for NICUs with transfer out rate greater than or equal to 10% (n=15 NICUs) was 82.5 days (interquartile range 80.4 – 83.5). Figure 3 displays the relationship between transfer-out rate and risk-adjusted LOS. The fitted regression line has a slope of 0.365 and R = 0.121. Overall, the impact of transfer-out rate on our risk-adjusted LOS appeared limited.


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)

Rate of transfer-out 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 =0.365, R = 0.121, R2 = 0.0146, p=0.207
© Copyright Policy
Related In: Results  -  Collection

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

Figure 3: Rate of transfer-out 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 =0.365, R = 0.121, R2 = 0.0146, p=0.207
Mentions: As our study included only infants who were discharged home, another potential bias that we considered was that hospitals that transferred more infants to lower levels of care for feeding and growing may have higher LOS. The average transfer-out rate for growth and discharge planning was 7.5% overall for ELBW infants, with range between 0 to 31%. The mean adjusted LOS for NICUs with transfer out rate < 10% (n=96 NICUs) was 80.7 days (interquartile range 79.1 – 83.0) while the mean adjusted LOS for NICUs with transfer out rate greater than or equal to 10% (n=15 NICUs) was 82.5 days (interquartile range 80.4 – 83.5). Figure 3 displays the relationship between transfer-out rate and risk-adjusted LOS. The fitted regression line has a slope of 0.365 and R = 0.121. Overall, the impact of transfer-out rate on our risk-adjusted LOS appeared limited.

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