Variation in Hospital Mortality in an Australian Neonatal Intensive Care Unit Network

Overview

Journal Arch Dis Child Fetal Neonatal Ed

Specialties Gynecology & Obstetrics
Pediatrics

Date 2017 Oct 28

PMID 29074720

Citations 7

Authors

Mohamed E Abdel-Latif

Gen Nowak

Barbara Bajuk

Kathryn Glass

David Harley

Affiliations

Soon will be listed here.

Abstract

Background: Studying centre-to-centre (CTC) variation in mortality rates is important because inferences about quality of care can be made permitting changes in practice to improve outcomes. However, comparisons between hospitals can be misleading unless there is adjustment for population characteristics and severity of illness.

Objective: We sought to report the risk-adjusted CTC variation in mortality among preterm infants born <32 weeks and admitted to all eight tertiary neonatal intensive care units (NICUs) in the New South Wales and the Australian Capital Territory Neonatal Network (NICUS), Australia.

Methods: We analysed routinely collected prospective data for births between 2007 and 2014. Adjusted mortality rates for each NICU were produced using a multiple logistic regression model. Output from this model was used to construct funnel plots.

Results: A total of 7212 live born infants <32 weeks gestation were admitted consecutively to network NICUs during the study period. NICUs differed in their patient populations and severity of illness.The overall unadjusted hospital mortality rate for the network was 7.9% (n=572 deaths). This varied from 5.3% in hospital E to 10.4% in hospital C. Adjusted mortality rates showed little CTC variation. No hospital reached the +99.8% control limit level on adjusted funnel plots.

Conclusion: Characteristics of infants admitted to NICUs differ, and comparing unadjusted mortality rates should be avoided. Logistic regression-derived risk-adjusted mortality rates plotted on funnel plots provide a powerful visual graphical tool for presenting quality performance data. CTC variation is readily identified, permitting hospitals to appraise their practices and start timely intervention.

Citing Articles

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Lee M, Lee J, Chang Y Sci Rep. 2024; 14(1):20959.

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Variation in hospital morbidities in an Australian neonatal intensive care unit network.

Abdel-Latif M, Adegboye O, Nowak G, Elfaki F, Bajuk B, Glass K Arch Dis Child Fetal Neonatal Ed. 2023; 108(4):400-407.

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Exploring variation in quality of care and clinical outcomes between neonatal units: a novel use for the UK National Neonatal Audit Programme (NNAP).

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