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Yeung T, Ahmed A, Wong J, Toye J, Abou Mehrem A, Mukerji A, Lapointe A, Ng E, Beltempo M, Pechlivanoglou P, Lee S, Shah PS. Variations in Site-Specific Costs for Infants Born Extremely Preterm in Canadian Neonatal Intensive Care Units. J Pediatr 2024; 266:113863. [PMID: 38096975 DOI: 10.1016/j.jpeds.2023.113863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 11/19/2023] [Accepted: 11/29/2023] [Indexed: 02/01/2024]
Abstract
OBJECTIVE To quantify site-specific costs and their association with survival without major morbidity (SWMM) in Canada for neonates <28 weeks of gestation admitted to large tertiary neonatal intensive care units. METHODS We conducted a retrospective analysis of infants born at <28 weeks of gestation and admitted to Canadian Neonatal Network sites from 2010 through 2021. Sites that cared for at least 50 eligible infants by gestational age in weeks over the study period were included. Using a validated costing algorithm that assessed physician, nursing, respiratory therapy, diagnostic imaging, transfusions, procedural, medication, and certain indirect costs, we calculated site and resource-specific costs in 2017 Canadian dollars (CAD) and evaluated their relationship with SWMM. RESULTS Seven sites with 8180 (range 841-1605) eligible neonates with a mean (SD) gestation of 25.4 [1.3] weeks were included. Survival to discharge or transfer was 85.3% with a mean (SD) length of stay of 75 (46) days. The mean (SD) total and daily costs per neonate varied between $94 992 ($60 283) and $174 438 ($130 501) CAD and $1833 ($916) to $2307 ($1281) CAD, respectively. Between sites, there was no relationship between costs and SWMM. CONCLUSIONS There was marked variation in costs and SWMM between sites in Canada with universal health care. The lack of concordance between both outcomes and costs among sites may provide possibilities for outcomes improvement and cost containment.
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Affiliation(s)
- Telford Yeung
- Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada; Section of Neonatology, Windsor Regional Hospital Metropolitan Campus, Windsor, Ontario, Canada
| | - Asma Ahmed
- Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jonathan Wong
- BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Jennifer Toye
- Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Ayman Abou Mehrem
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Amit Mukerji
- McMaster Children's Hospital, Hamilton, Ontario, Canada
| | | | - Eugene Ng
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Marc Beltempo
- Montreal Children's Hospital, Montreal, Quebec, Canada
| | - Petros Pechlivanoglou
- Hospital for Sick Children, Toronto, Ontario, Canada; Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy Management and Evaluation, Toronto, Ontario, Canada
| | - Shoo Lee
- Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada; Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada; Mother-Infant Care Research Center, Toronto, Ontario, Canada
| | - Prakesh S Shah
- Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada; Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy Management and Evaluation, Toronto, Ontario, Canada; Mother-Infant Care Research Center, Toronto, Ontario, Canada.
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Lapcharoensap W, Bennett M, Xu X, Lee HC, Profit J, Dukhovny D. Quality, outcome, and cost of care provided to very low birth weight infants in California. J Perinatol 2024; 44:224-230. [PMID: 37805592 DOI: 10.1038/s41372-023-01792-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 09/21/2023] [Accepted: 09/25/2023] [Indexed: 10/09/2023]
Abstract
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.
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Affiliation(s)
- Wannasiri Lapcharoensap
- Division of Neonatology, Department of Pediatrics, Oregon Health and Science University, Portland, OR, 97239, USA.
| | - Mihoko Bennett
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University, Stanford, CA, 94305, USA
- California Perinatal Quality Care Collaborative, Stanford, CA, 94305, USA
| | - Xiao Xu
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University, New Haven, CT, 06520, USA
| | - Henry C Lee
- California Perinatal Quality Care Collaborative, Stanford, CA, 94305, USA
- Division of Neonatology, Department of Pediatrics, University of California San Diego, La Jolla, CA, 92093, USA
| | - Jochen Profit
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University, Stanford, CA, 94305, USA
- California Perinatal Quality Care Collaborative, Stanford, CA, 94305, USA
| | - Dmitry Dukhovny
- Division of Neonatology, Department of Pediatrics, Oregon Health and Science University, Portland, OR, 97239, USA
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Kaempf JW, Gautham K. Do small baby units improve extremely premature infant outcomes? J Perinatol 2022; 42:281-285. [PMID: 34012054 DOI: 10.1038/s41372-021-01076-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 03/25/2021] [Accepted: 04/26/2021] [Indexed: 11/09/2022]
Abstract
Increasing numbers of neonatal intensive care units have formed small baby units or small baby teams with the intention to optimize care of extremely premature infants. Considerable time, energy, and resources are required to develop and sustain complex quality improvement constructs, so legitimate questions about effectiveness, unintended consequences, and lost opportunity costs warrant scrutiny. The small baby unit literature is diminutive. Errors of chance, bias, and confounding secondary to insufficient definitions of process and outcome metrics, overlapping quality improvement projects, and limited cost analyses restrict firm conclusions. Well-established quality improvement methodologies such as evidence-based guidelines, standardized variability reduction using measurement-and-adjust techniques, family-integrated focus, and developmentally sensitive care, reliably improve outcomes for all-sized premature infants. There is not compelling published evidence that adding specialized small baby units or designated teams for extremely premature infants further enhances short- or long-term health if robust quality improvement fundamentals are already imbedded within local culture.
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Affiliation(s)
- Joseph W Kaempf
- Providence Health System, Women and Children's Services, Providence St. Vincent Medical Center, 9205 SW Barnes Road, Portland, OR, 97225, USA.
| | - Kanekal Gautham
- Baylor College of Medicine, Texas Children's Hospital, 6621 Fannin St, Suite W6104, Houston, TX, 77030, USA
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