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Economic and health consequences of non-invasive respiratory support in newborn infants: a difference-in-difference analysis using data from the Norwegian patient registry.

Kann IC, Solevåg AL - BMC Health Serv Res (2014)

Bottom Line: We found a reduction in morbidity including bronchopulmonary dysplasia, retinopathy of prematurity and intraventricular hemorrhage.We found a reduction in number of hospital days and hospital costs for preterm infants with gestational age <28 weeks and for term infants with diagnoses affecting respiration.We conclude that increasing use of n-BiPAP may improve health and reduce costs.

View Article: PubMed Central - PubMed

Affiliation: The Health Services Research Centre HØKH, Akershus University Hospital, Lørenskog, Norway. Inger.Cathrine.Kann@ahus.no.

ABSTRACT

Background: Newborn infants with respiratory failure are often treated with intubation and mechanical ventilation for prolonged periods of time. Our objective was to evaluate whether increasing use of non-invasive respiratory support in newborn infants can improve patient health and reduce costs.

Methods: We utilized a natural experiment that took place in October 2008 when a large neonatal intensive care unit in Norway moved into a new hospital building with new medical equipment. A change in respiratory support towards increasing use of nasal biphasic positive airway pressure (n-BiPAP) instead of invasive mechanical ventilation treatment followed the acquisition of the new equipment. We used a difference-in-difference method and data from the Norwegian National Patient Registry to assess morbidity, mortality, number of hospital days and hospital costs in our unit following this change. We stratified the results according to gestational age groups.

Results: We found a reduction in morbidity including bronchopulmonary dysplasia, retinopathy of prematurity and intraventricular hemorrhage. No change in mortality was found. We found a reduction in number of hospital days and hospital costs for preterm infants with gestational age <28 weeks and for term infants with diagnoses affecting respiration.

Conclusions: We conclude that increasing use of n-BiPAP may improve health and reduce costs. However, more research is needed to establish best practice. Comparing hospitals where treatment practices change to hospitals where the same change does not occur may be a useful way to evaluate the efficacy of such a change, especially when hospitals can be studied over time.

No MeSH data available.


Related in: MedlinePlus

Flow chart describing the study population. *’Respiratory symptoms’ include the diagnoses respiratory failure, respiratory distress syndrome, persistent pulmonary hypertension, transitory tachypnoe of the newborn/wet lung, meconium aspiration syndrome and perinatal asphyxia.
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Fig1: Flow chart describing the study population. *’Respiratory symptoms’ include the diagnoses respiratory failure, respiratory distress syndrome, persistent pulmonary hypertension, transitory tachypnoe of the newborn/wet lung, meconium aspiration syndrome and perinatal asphyxia.

Mentions: The NPR assigned patients with a new identification (ID) number each year, and in each hospital, the patients were admitted before 2008. After 2008, the NPR allows for tracking individual patients between years and hospitals. In order to make data after 2008 comparable with those before 2008, we gave each patient a new ID for each year and hospital. We stratified the data according to the gestational age groups extremely preterm infants (GA <28 weeks), other preterm infants (GA ≥28 but <37 weeks), and term infants with respiratory symptoms (Figure 1).Figure 1


Economic and health consequences of non-invasive respiratory support in newborn infants: a difference-in-difference analysis using data from the Norwegian patient registry.

Kann IC, Solevåg AL - BMC Health Serv Res (2014)

Flow chart describing the study population. *’Respiratory symptoms’ include the diagnoses respiratory failure, respiratory distress syndrome, persistent pulmonary hypertension, transitory tachypnoe of the newborn/wet lung, meconium aspiration syndrome and perinatal asphyxia.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4232673&req=5

Fig1: Flow chart describing the study population. *’Respiratory symptoms’ include the diagnoses respiratory failure, respiratory distress syndrome, persistent pulmonary hypertension, transitory tachypnoe of the newborn/wet lung, meconium aspiration syndrome and perinatal asphyxia.
Mentions: The NPR assigned patients with a new identification (ID) number each year, and in each hospital, the patients were admitted before 2008. After 2008, the NPR allows for tracking individual patients between years and hospitals. In order to make data after 2008 comparable with those before 2008, we gave each patient a new ID for each year and hospital. We stratified the data according to the gestational age groups extremely preterm infants (GA <28 weeks), other preterm infants (GA ≥28 but <37 weeks), and term infants with respiratory symptoms (Figure 1).Figure 1

Bottom Line: We found a reduction in morbidity including bronchopulmonary dysplasia, retinopathy of prematurity and intraventricular hemorrhage.We found a reduction in number of hospital days and hospital costs for preterm infants with gestational age <28 weeks and for term infants with diagnoses affecting respiration.We conclude that increasing use of n-BiPAP may improve health and reduce costs.

View Article: PubMed Central - PubMed

Affiliation: The Health Services Research Centre HØKH, Akershus University Hospital, Lørenskog, Norway. Inger.Cathrine.Kann@ahus.no.

ABSTRACT

Background: Newborn infants with respiratory failure are often treated with intubation and mechanical ventilation for prolonged periods of time. Our objective was to evaluate whether increasing use of non-invasive respiratory support in newborn infants can improve patient health and reduce costs.

Methods: We utilized a natural experiment that took place in October 2008 when a large neonatal intensive care unit in Norway moved into a new hospital building with new medical equipment. A change in respiratory support towards increasing use of nasal biphasic positive airway pressure (n-BiPAP) instead of invasive mechanical ventilation treatment followed the acquisition of the new equipment. We used a difference-in-difference method and data from the Norwegian National Patient Registry to assess morbidity, mortality, number of hospital days and hospital costs in our unit following this change. We stratified the results according to gestational age groups.

Results: We found a reduction in morbidity including bronchopulmonary dysplasia, retinopathy of prematurity and intraventricular hemorrhage. No change in mortality was found. We found a reduction in number of hospital days and hospital costs for preterm infants with gestational age <28 weeks and for term infants with diagnoses affecting respiration.

Conclusions: We conclude that increasing use of n-BiPAP may improve health and reduce costs. However, more research is needed to establish best practice. Comparing hospitals where treatment practices change to hospitals where the same change does not occur may be a useful way to evaluate the efficacy of such a change, especially when hospitals can be studied over time.

No MeSH data available.


Related in: MedlinePlus