2025-06-25 ペンシルベニア州立大学(PennState)
<関連情報>
- https://www.psu.edu/news/health-and-human-development/story/outcomes-very-preterm-infants-may-vary-across-health-systems
- https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2834754
- https://academic.oup.com/healthaffairsscholar/article/1/3/qxad042/7267480
超早産児の転帰は医療システムによって異なる可能性がある Outcomes for Very Preterm Infants Across Health Systems
Jeannette A. Rogowski, PhD; Lucy Greenberg, MS; Erika M. Edwards, PhD, MPH; et al
JAMA Network Open Published:June 2, 2025
DOI:10.1001/jamanetworkopen.2025.13274
Key Points
Question Is there variation in outcomes for very preterm infants across health systems in the US?
Findings In this cross-sectional study of 38 501 infants, variation in mortality across health systems was 1.5% of the total variance and 5.2% for length of stay among surviving infants. However, the 2–percentage point difference in mortality among systems in the highest and lowest performing quartiles and 12-day difference in length of stay among surviving infants were potentially clinically meaningful.
Meaning These findings suggest that opportunities for health systems to improve quality exist, thereby decreasing mortality and length of stay for very preterm infants.
Abstract
Importance As a result of consolidation in the health care delivery system, most very preterm infants in the US are born and receive care in multihospital health systems. The extent of variation in patient outcomes and length of stay for this vulnerable population across health systems and across hospitals within systems is not known.
Objective To evaluate the extent of variation in mortality and length of stay within and across health systems for infants born very preterm (gestational age 24-29 weeks).
Design, Setting, and Participants This cross-sectional study examined data contributed by Vermont Oxford Network US member hospitals in 224 health systems that delivered care to very preterm infants born between January 1, 2021, and December 31, 2022.
Exposure Receipt of neonatal intensive care unit (NICU) care in a horizontally integrated multihospital health system.
Main Outcomes and Measures Mortality rates and length of stay among surviving infants were estimated using multilevel logistic and linear models.
Results The sample included 38 501 infants (median [IQR] gestational age, 27 [26-28] weeks; 52.8% boys). The median (IQR) number of infants receiving care at a hospital system during the 2-year period was 108 (59-198); 91.0% were born at the reporting hospital, and 95.4% were born in the reporting system. The mean adjusted mortality rate in the highest performing quartile of systems was 7.8% (95% credible interval [CrI], 7.3%-8.3%) compared with 9.8% (95% CrI, 9.1%-10.7%) for the lowest performing quartile. The mean adjusted length of stay for surviving infants ranged from 78 days (95% CrI, 77-79 days) to 90 days (95% CrI, 88-91 days) between the highest and lowest performing quartiles of systems, respectively.
Conclusions and Relevance In this cross-sectional study of very preterm infants, there was a 2–percentage point difference in mortality between systems in the highest and lowest performing quartiles and a 12-day difference in mean length of stay among surviving infants, which are potentially clinically meaningful. Opportunities exist for health systems to improve quality at the health system level to decrease mortality among infants born very preterm and reduce resources used in patient care.
水平統合された医療システムと超早産児の新生児集中治療室(NICU)ケア Horizontally integrated health systems and neonatal intensive care unit (NICU) care for very preterm infants
Jeannette Rogowski , Lucy Greenberg , Erika Edwards , Danielle Ehret , Jeffrey Horbar
Health Affairs Scholar Published:11 September 2023
DOI:https://doi.org/10.1093/haschl/qxad042
Abstract
Hospital care has consolidated rapidly into health systems in the United States. Infants born very preterm are among the most vulnerable pediatric populations, accounting for the majority of infant deaths each year. The pediatric health care delivery system for infants is unique as the birth hospitalization includes 2 patients, the mother and the infant. Further, regionalization goals for infants who are born preterm require care to be provided at neonatal intensive care units (NICUs) with the capacity to treat them. National patient-level data from the Vermont Oxford Network demonstrates that most very preterm infants were born in a horizontally integrated, multi-hospital system (84%), and they tended to remain in the system for their entire hospitalization, including for risk-appropriate NICU care. Half of the infants were cared for in large systems with more than 10 hospitals that were disproportionately cross-market systems. With high transfer rates between hospitals (21%) it will be important to determine the implications of consolidation for the quality of care and patient-centeredness for families. The care for very preterm infants is important from a policy perspective as hospitalized newborn infants account for 21% of hospitalizations in Medicaid each year and 10% of aggregate hospital costs.
