Outcomes for Very Preterm Infants Across Health Systems.

IF 10.5 1区医学 Q1 MEDICINE, GENERAL & INTERNAL

JAMA Network Open Pub Date : 2025-06-02 DOI:10.1001/jamanetworkopen.2025.13274

Jeannette A Rogowski, Lucy Greenberg, Erika M Edwards, Danielle E Y Ehret, Jeffrey S Buzas, Jeffrey D Horbar

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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.

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各卫生系统中极早产儿的结局。

重要性：由于卫生保健服务系统的整合，美国大多数极早产儿在多医院卫生系统中出生并接受护理。目前尚不清楚各卫生系统和各系统内医院之间患者预后和这一弱势群体住院时间的差异程度。目的：评估极早产婴儿（胎龄24-29周）的死亡率和在卫生系统内和跨卫生系统住院时间的差异程度。设计、环境和参与者：本横断面研究检查了佛蒙特牛津网络美国成员医院在224个卫生系统中提供的数据，这些卫生系统为2021年1月1日至2022年12月31日出生的极早产儿提供护理。暴露：接受新生儿重症监护病房（NICU）护理在一个水平整合的多医院卫生系统。主要结局和措施：使用多层逻辑模型和线性模型估计存活婴儿的死亡率和住院时间。结果：样本包括38 501例婴儿(中位[IQR]胎龄27[26-28]周；52.8%的男孩)。在2年期间，在医院系统接受护理的婴儿中位数（IQR）为108 (59-198)；91.0%出生在报告医院，95.4%出生在报告系统。系统中表现最好的四分位数的平均调整死亡率为7.8%(95%可信区间[CrI]， 7.3%-8.3%)，而表现最差的四分位数的平均调整死亡率为9.8%（95%可信区间[CrI]， 9.1%-10.7%）。存活婴儿的平均调整住院时间分别为78天（95% CrI， 77-79天）至90天（95% CrI， 88-91天），分别为系统表现最高和最低的四分位数。结论和相关性：在这项对极早产儿的横断面研究中，在表现最高和最低四分位数的系统中，死亡率有2个百分点的差异，存活婴儿的平均住院时间有12天的差异，这可能具有临床意义。卫生系统有机会在卫生系统层面提高质量，以降低极早产婴儿的死亡率，并减少用于患者护理的资源。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

JAMA Network Open Medicine-General Medicine

CiteScore

16.00

自引率

2.90%

发文量

2126

审稿时长

16 weeks

期刊介绍： JAMA Network Open, a member of the esteemed JAMA Network, stands as an international, peer-reviewed, open-access general medical journal.The publication is dedicated to disseminating research across various health disciplines and countries, encompassing clinical care, innovation in health care, health policy, and global health. JAMA Network Open caters to clinicians, investigators, and policymakers, providing a platform for valuable insights and advancements in the medical field. As part of the JAMA Network, a consortium of peer-reviewed general medical and specialty publications, JAMA Network Open contributes to the collective knowledge and understanding within the medical community.