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Quality, outcome, and cost of care provided to very low birth weight infants in California

Journal of Perinatology volume 44, pages 224–230 (2024)Cite this article

Subjects

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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Fig. 1: Study cohort population flow diagram.
Fig. 2: Variation of Quality, Outcomes, and Costs per VLBW hospitalization among California NICUs.
Fig. 3: Relationship between risk-standardized costs and (a) Baby-MONITOR score and (b) risk-adjusted survival without major morbidity.

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Data availability

The data that support the findings of this study are available from CPQCC but restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available. Data are however available from the authors upon reasonable request and with permission of CPQCC.

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Funding

The project was sponsored in part by grant number R01 HD087425 from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD). The content is solely the responsibility of the authors and does not necessarily represent the official views of the Eunice Kennedy Shriver NICHD or National Institutes of Health.

Author information

Author notes

  1. Henry C. Lee

    Present address: Division of Neonatology, Department of Pediatrics, University of California San Diego, La Jolla, CA, 92093, USA

Authors and Affiliations

  1. Division of Neonatology, Department of Pediatrics, Oregon Health and Science University, Portland, OR, 97239, USA

    Wannasiri Lapcharoensap & Dmitry Dukhovny

  2. Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University, Stanford, CA, 94305, USA

    Mihoko Bennett & Jochen Profit

  3. California Perinatal Quality Care Collaborative, Stanford, CA, 94305, USA

    Mihoko Bennett, Henry C. Lee & Jochen Profit

  4. Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University, New Haven, CT, 06520, USA

    Xiao Xu

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  1. Wannasiri Lapcharoensap
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  4. Henry C. Lee
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Contributions

WL and DD conceptualized and designed the study, drafted the manuscript, and reviewed and revised the manuscript. MB designed the data collection instruments, collected data, carried out the analyses, and reviewed and revised the manuscript. HCL, JP and XX conceptualized and designed the study, and critically reviewed and revised the manuscript for important intellectual content. All authors reviewed and approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

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Correspondence to Wannasiri Lapcharoensap.

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Lapcharoensap, W., Bennett, M., Xu, X. et al. Quality, outcome, and cost of care provided to very low birth weight infants in California. J Perinatol 44, 224–230 (2024). https://doi.org/10.1038/s41372-023-01792-4

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