Neonatologist Staffing is Related to the Inter-hospital Variation of Risk-adjusted Mortality of Very Low Birth Weight Infants in Korea

Overview

Journal Sci Rep

Specialty Science

Date 2024 Sep 9

PMID 39251660

Authors

Myung Hee Lee

Jang Hoon Lee

Yun Sil Chang

Affiliations

Soon will be listed here.

Abstract

This study investigated whether hospital factors, including patient volume, unit level, and neonatologist staffing, were associated with variations in standardized mortality ratios (SMR) adjusted for patient factors in very-low-birth-weight infants (VLBWIs). A total of 15,766 VLBWIs born in 63 hospitals between 2013 and 2020 were analyzed using data from the Korean Neonatal Network cohort. SMRs were evaluated after adjusting for patient factors. High and low SMR groups were defined as hospitals outside the 95% confidence limits on the SMR funnel plot. The mortality rate of VLBWIs was 12.7%. The average case-mix SMR was 1.1; calculated by adjusting for six significant patient factors: antenatal steroid, gestational age, birth weight, sex, 5-min Apgar score, and congenital anomalies. Hospital factors of the low SMR group (N = 10) had higher unit levels, more annual volumes of VLBWIs, more number of neonatologists, and fewer neonatal intensive care beds per neonatologist than the high SMR group (N = 13). Multi-level risk adjustment revealed that only the number of neonatologists showed a significant fixed-effect on mortality besides fixed patient risk effect and a random hospital effect. Adjusting for the number of neonatologists decreased the variance partition coefficient and random-effects variance between hospitals by 11.36%. The number of neonatologists was independently associated with center-to-center differences in VLBWI mortality in Korea after adjustment for patient risks and hospital factors.

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References

Hack M, Wright L, Shankaran S, Tyson J, Horbar J, Bauer C . Very-low-birth-weight outcomes of the National Institute of Child Health and Human Development Neonatal Network, November 1989 to October 1990. Am J Obstet Gynecol. 1995; 172(2 Pt 1):457-64. DOI: 10.1016/0002-9378(95)90557-x. View

Stoll B, Hansen N, Bell E, Walsh M, Carlo W, Shankaran S . Trends in Care Practices, Morbidity, and Mortality of Extremely Preterm Neonates, 1993-2012. JAMA. 2015; 314(10):1039-51. PMC: 4787615. DOI: 10.1001/jama.2015.10244. View

Lee S, McMillan D, Ohlsson A, Pendray M, Synnes A, Whyte R . Variations in practice and outcomes in the Canadian NICU network: 1996-1997. Pediatrics. 2000; 106(5):1070-9. DOI: 10.1542/peds.106.5.1070. View

Tommiska V, Heinonen K, Ikonen S, Kero P, Pokela M, Renlund M . A national short-term follow-Up study of extremely low birth weight infants born in Finland in 1996-1997. Pediatrics. 2001; 107(1):E2. DOI: 10.1542/peds.107.1.e2. View

Berger T, Steurer M, Woerner A, Meyer-Schiffer P, Adams M . Trends and centre-to-centre variability in survival rates of very preterm infants (<32 weeks) over a 10-year-period in Switzerland. Arch Dis Child Fetal Neonatal Ed. 2012; 97(5):F323-8. DOI: 10.1136/fetalneonatal-2011-301008. View

Rogowski J, Horbar J, Staiger D, Kenny M, Carpenter J, Geppert J . Indirect vs direct hospital quality indicators for very low-birth-weight infants. JAMA. 2004; 291(2):202-9. DOI: 10.1001/jama.291.2.202. View

Horbar J, Badger G, Lewit E, Rogowski J, Shiono P . Hospital and patient characteristics associated with variation in 28-day mortality rates for very low birth weight infants. Vermont Oxford Network. Pediatrics. 1997; 99(2):149-56. DOI: 10.1542/peds.99.2.149. View

Simpson J, Evans N, Gibberd R, Heuchan A, Henderson-Smart D . Analysing differences in clinical outcomes between hospitals. Qual Saf Health Care. 2003; 12(4):257-62. PMC: 1743752. DOI: 10.1136/qhc.12.4.257. View

Lilford R, Mohammed M, Spiegelhalter D, Thomson R . Use and misuse of process and outcome data in managing performance of acute medical care: avoiding institutional stigma. Lancet. 2004; 363(9415):1147-54. DOI: 10.1016/S0140-6736(04)15901-1. View

10.

Kleinman J . Indirect standardization of neonatal mortality for birth weight. Int J Epidemiol. 1982; 11(2):146-54. DOI: 10.1093/ije/11.2.146. View

11.

de Castro E, Leite A, Almeida M, Guinsburg R . Perinatal factors associated with early neonatal deaths in very low birth weight preterm infants in Northeast Brazil. BMC Pediatr. 2014; 14:312. PMC: 4308919. DOI: 10.1186/s12887-014-0312-5. View

12.

Johansson A, Dickman P, Kramer M, Cnattingius S . Maternal smoking and infant mortality: does quitting smoking reduce the risk of infant death?. Epidemiology. 2009; 20(4):590-7. DOI: 10.1097/EDE.0b013e31819dcc6a. View

13.

Park J, Chang Y, Ahn S, Sung S, Park W . Predicting mortality in extremely low birth weight infants: Comparison between gestational age, birth weight, Apgar score, CRIB II score, initial and lowest serum albumin levels. PLoS One. 2018; 13(2):e0192232. PMC: 5811008. DOI: 10.1371/journal.pone.0192232. View

14.

Miyata H, Hashimoto H, Horiguchi H, Matsuda S, Motomura N, Takamoto S . Performance of in-hospital mortality prediction models for acute hospitalization: hospital standardized mortality ratio in Japan. BMC Health Serv Res. 2008; 8:229. PMC: 2606685. DOI: 10.1186/1472-6963-8-229. View

15.

Abdel-Latif M, Nowak G, Bajuk B, Glass K, Harley D . Variation in hospital mortality in an Australian neonatal intensive care unit network. Arch Dis Child Fetal Neonatal Ed. 2017; 103(4):F331-F336. PMC: 6047145. DOI: 10.1136/archdischild-2017-313222. View

16.

Rosenblatt R, Mayfield J, HART L, Baldwin L . Outcomes of regionalized perinatal care in Washington State. West J Med. 1988; 149(1):98-102. PMC: 1026272. View

17.

Mohammed M, Manktelow B, Hofer T . Comparison of four methods for deriving hospital standardised mortality ratios from a single hierarchical logistic regression model. Stat Methods Med Res. 2012; 25(2):706-15. DOI: 10.1177/0962280212465165. View

18.

Bartels D, Wypij D, Wenzlaff P, Dammann O, Poets C . Hospital volume and neonatal mortality among very low birth weight infants. Pediatrics. 2006; 117(6):2206-14. DOI: 10.1542/peds.2005-1624. View

19.

Phibbs C, Baker L, Caughey A, Danielsen B, Schmitt S, Phibbs R . Level and volume of neonatal intensive care and mortality in very-low-birth-weight infants. N Engl J Med. 2007; 356(21):2165-75. DOI: 10.1056/NEJMsa065029. View

20.

Chung J, Phibbs C, Boscardin W, Kominski G, Ortega A, Needleman J . The effect of neonatal intensive care level and hospital volume on mortality of very low birth weight infants. Med Care. 2010; 48(7):635-44. DOI: 10.1097/MLR.0b013e3181dbe887. View