First name
Ciaran
Middle name
S
Last name
Phibbs

Title

The effect of severe maternal morbidity on infant costs and lengths of stay.

Year of Publication

2022

Date Published

2022 Feb 18

ISSN Number

1476-5543

Abstract

<p><strong>OBJECTIVE: </strong>To examine the association between severe maternal morbidity (SMM) and infant health using the additional infant costs and length of stay (LOS) as markers of added clinical complexity.</p>

<p><strong>STUDY DESIGN: </strong>Secondary data analysis using California linked birth certificate-patient discharge data for 2009-2011 (N = 1,260,457). Regression models were used to estimate the association between SMM and infant costs and LOS.</p>

<p><strong>RESULTS: </strong>The 16,687 SMM-exposed infants experienced a $6550 (33%) increase in costs and a 0.7 (18%) day increase in LOS. Preterm infants had ($11,258 (18%) added costs and 1.3 days (8.1%) longer LOS) than term infants ($2539 (38%) added costs and 0.5 days (22%) longer LOS).</p>

<p><strong>CONCLUSIONS: </strong>SMM was associated with increased infant costs and LOS, suggesting that SMM may have adverse health effects for infants, including term infants. The relatively larger effect on costs indicates an increase in treatment intensity (clinical severity) greater than additional LOS.</p>

DOI

10.1038/s41372-022-01343-3

Alternate Title

J Perinatol

PMID

35184145

Title

A Comprehensive Analysis of the Costs of Severe Maternal Morbidity.

Year of Publication

2022

Date Published

2022 Jan 11

ISSN Number

1878-4321

Abstract

<p><strong>INTRODUCTION: </strong>The objectives of this study were to include readmissions and physician costs in the estimates of total costs of severe maternal morbidity (SMM), to consider the effect of SMM on maternal length of stay (LOS), and to examine these for the more restricted definition of SMM that excludes transfusion-only cases.</p>

<p><strong>METHODS: </strong>California linked birth certificate-patient discharge data for 2009 through 2011 (n&nbsp;=&nbsp;1,262,862) with complete costs and LOS were used in a secondary data analysis. Cost-to-charge ratios were used to estimate costs from charges, adjusting for inflation. Physician payments were estimated from the mean payments for specific diagnosis-related groups. Generalized linear models estimated the association between SMM and costs and LOS.</p>

<p><strong>RESULTS: </strong>Excluding readmissions and physician costs, SMM was associated with a 60% increase in hospital costs (marginal effect [ME], $3,550) and a 33% increase in LOS (ME 0.9&nbsp;days). These increased to 70% (ME $5,806) and 46% (ME 1.3&nbsp;days) when physician costs and readmissions were included. The effects of SMM were roughly one-half as large for patients who only required a blood transfusion (49% [ME $4,056] and 31% [ME 0.9&nbsp;days]) as for patients who had another indicator for SMM (93% [ME $7,664] and 62% [ME 1.7&nbsp;days]).</p>

<p><strong>CONCLUSIONS: </strong>Postpartum hospital readmissions and physician costs are important and previously unreported contributors to the costs of SMM. Excess costs and LOS associated with SMM vary considerably by indication. Cost effects were larger than the LOS effects, indicating that SMM increases treatment intensity beyond increasing LOS, and decreasing SMM may have broader health and cost benefits than previously understood.</p>

DOI

10.1016/j.whi.2021.12.006

Alternate Title

Womens Health Issues

PMID

35031196

Title

Understanding the relative contributions of prematurity and congenital anomalies to neonatal mortality.

Year of Publication

2022

Date Published

2022 Jan 16

ISSN Number

1476-5543

Abstract

<p><strong>OBJECTIVE: </strong>To examine the relative contributions of preterm delivery and congenital anomalies to neonatal mortality.</p>

<p><strong>STUDY DESIGN: </strong>Retrospective analysis of 2009-2011 linked birth cohort-hospital discharge files for California, Missouri, Pennsylvania and South Carolina. Deaths were classified by gestational age and three definitions of congenital anomaly: any ICD-9 code for an anomaly, any anomaly with a significant mortality risk, and anomalies recorded on the death certificate.</p>

<p><strong>RESULT: </strong>In total, 59% of the deaths had an ICD-9 code for an anomaly, only 43% had a potentially fatal anomaly, and only 34% had a death certificate anomaly. Preterm infants (&lt;37 weeks GA) accounted for 80% of deaths; those preterm infants without a potentially fatal anomaly diagnosis comprised 53% of all neonatal deaths. The share of preterm deaths with a potentially fatal anomaly decreases with GA.</p>

<p><strong>CONCLUSION: </strong>Congenital anomalies are responsible for about 40% of neonatal deaths while preterm without anomalies are responsible for over 50%.</p>

DOI

10.1038/s41372-021-01298-x

Alternate Title

J Perinatol

PMID

35034095

Title

Birth Volume and Geographic Distribution of US Hospitals With Obstetric Services From 2010 to 2018.

Year of Publication

2021

Number of Pages

e2125373

Date Published

2021 Oct 01

ISSN Number

2574-3805

Abstract

<p><strong>Importance: </strong>Timely access to clinically appropriate obstetric services is critical to the provision of high-quality perinatal care.</p>

<p><strong>Objective: </strong>To examine the geographic distribution, proximity, and urban adjacency of US obstetric hospitals by annual birth volume.</p>

<p><strong>Design, Setting, and Participants: </strong>This retrospective population-based cohort study identified US hospitals with obstetric services using the American Hospital Association (AHA) Annual Survey of Hospitals and Centers for Medicare &amp; Medicaid provider of services data from 2010 to 2018. Obstetric hospitals with 10 or more births per year were included in the study. Data analysis was performed from November 6, 2020, to April 5, 2021.</p>

<p><strong>Exposure: </strong>Hospital birth volume, defined by annual birth volume categories of 10 to 500, 501 to 1000, 1001 to 2000, and more than 2000 births.</p>

<p><strong>Main Outcomes and Measures: </strong>Outcomes assessed by birth volume category were percentage of births (from annual AHA data), number of hospitals, geographic distribution of hospitals among states, proximity between obstetric hospitals, and urban adjacency defined by urban influence codes, which classify counties by population size and adjacency to a metropolitan area.</p>

<p><strong>Results: </strong>The study included 26 900 hospital-years of data from 3207 distinct US hospitals with obstetric services, reflecting 34 054 951 associated births. Most infants (19 327 487 [56.8%]) were born in hospitals with more than 2000 births/y, and 2 528 259 (7.4%) were born in low-volume (10-500 births/y) hospitals. More than one-third of obstetric hospitals (37.4%; 10 064 hospital-years) were low volume. A total of 46 states had obstetric hospitals in all volume categories. Among low-volume hospitals, 18.9% (1904 hospital-years) were not within 30 miles of any other obstetric hospital and 23.9% (2400 hospital-years) were within 30 miles of a hospital with more than 2000 deliveries/y. Isolated hospitals (those without another obstetric hospital within 30 miles) were more frequently low volume, with 58.4% (1112 hospital-years) located in noncore rural areas.</p>

<p><strong>Conclusions and Relevance: </strong>In this cohort study, marked variations were found in birth volume, geographic distribution, proximity, and urban adjacency among US obstetric hospitals from 2010 to 2018. The findings related to geographic isolation and rural-urban distribution of low-volume obstetric hospitals suggest the need to balance proximity with volume to optimize effective referral and access to high-quality perinatal care.</p>

DOI

10.1001/jamanetworkopen.2021.25373

Alternate Title

JAMA Netw Open

PMID

34623408

Title

Access to risk-appropriate hospital care and disparities in neonatal outcomes in racial/ethnic groups and rural-urban populations.

Year of Publication

2021

Number of Pages

151409

Date Published

2021 Mar 21

ISSN Number

1558-075X

Abstract

<p>Variations in infant and neonatal mortality continue to persist in the United States and in other countries based on both socio-demographic characteristics, such as race and ethnicity, and geographic location. One potential driver of these differences is variations in access to risk-appropriate delivery care. The purpose of this article is to present the&nbsp;importance of delivery hospitals on neonatal outcomes, discuss variation in access to these hospitals for high-risk infants and their mothers, and to provide insight into drivers for differences in access to high-quality perinatal care using the available literature.&nbsp;This review also illustrates the lack of information on a number of topics that are crucial to the development of evidence-based interventions to improve access to appropriate delivery hospital services and thus optimize the outcomes of high-risk mothers and their newborns.</p>

DOI

10.1016/j.semperi.2021.151409

Alternate Title

Semin Perinatol

PMID

33931237

Title

Racial Segregation and Inequality in the Neonatal Intensive Care Unit for Very Low-Birth-Weight and Very Preterm Infants.

Year of Publication

2019

Number of Pages

455-461

Date Published

2019 05 01

ISSN Number

2168-6211

Abstract

<p><strong>Importance: </strong>Racial and ethnic minorities receive lower-quality health care than white non-Hispanic individuals in the United States. Where minority infants receive care and the role that may play in the quality of care received is unclear.</p>

<p><strong>Objective: </strong>To determine the extent of segregation and inequality of care of very low-birth-weight and very preterm infants across neonatal intensive care units (NICUs) in the United States.</p>

<p><strong>Design, Setting, and Participants: </strong>This cohort study of 743 NICUs in the Vermont Oxford Network included 117 982 black, Hispanic, Asian, and white infants born at 401 g to 1500 g or 22 to 29 weeks' gestation from January 2014 to December 2016. Analysis began January 2018.</p>

<p><strong>Main Outcomes and Measures: </strong>The NICU segregation index and NICU inequality index were calculated at the hospital level as the Gini coefficients associated with the Lorenz curves for black, Hispanic, and Asian infants compared with white infants, with NICUs ranked by proportion of white infants for the NICU segregation index and by composite Baby-MONITOR (Measure of Neonatal Intensive Care Outcomes Research) score for the NICU inequality index.</p>

<p><strong>Results: </strong>Infants (36 359 black [31%], 21 808 Hispanic [18%], 5920 Asian [5%], and 53 895 white [46%]) were segregated among the 743 NICUs by race and ethnicity (NICU segregation index: black: 0.50 [95% CI, 0.46-0.53], Hispanic: 0.58 [95% CI, 0.54-0.61], and Asian: 0.45 [95% CI, 0.40-0.50]). Compared with white infants, black infants were concentrated at NICUs with lower-quality scores, and Hispanic and Asian infants were concentrated at NICUs with higher-quality scores (NICU inequality index: black: 0.07 [95% CI, 0.02-0.13], Hispanic: -0.10 [95% CI, -0.17 to -0.04], and Asian: -0.26 [95% CI, -0.32 to -0.19]). There was marked variation among the census regions in weighted mean NICU quality scores (range: -0.69 to 0.85). Region of residence explained the observed inequality for Hispanic infants but not for black or Asian infants.</p>

<p><strong>Conclusions and Relevance: </strong>Black, Hispanic, and Asian infants were segregated across NICUs, reflecting the racial segregation of minority populations in the United States. There were large differences between geographic regions in NICU quality. After accounting for these differences, compared with white infants, Asian infants received care at higher-quality NICUs and black infants, at lower-quality NICUs. Explaining these patterns will require understanding the effects of sociodemographic factors and public policies on hospital quality, access, and choice for minority women and their infants.</p>

DOI

10.1001/jamapediatrics.2019.0241

Alternate Title

JAMA Pediatr

PMID

30907924

Title

Racial and Ethnic Differences Over Time in Outcomes of Infants Born Less Than 30 Weeks' Gestation.

Year of Publication

2019

Date Published

2019 Sep

ISSN Number

1098-4275

Abstract

<p><strong>OBJECTIVES: </strong>To examine changes in care practices over time by race and ethnicity and whether the decrease in hospital mortality and severe morbidities has benefited infants of minority over infants of white mothers.</p>

<p><strong>METHODS: </strong>Infants 22 to 29 weeks' gestation born between January 2006 and December 2017 at a Vermont Oxford Network center in the United States were studied. We examined mortality and morbidity rate differences and 95% confidence intervals for African American and Hispanic versus white infants by birth year. We tested temporal differences in mortality and morbidity rates between white and African American or Hispanic infants using a likelihood ratio test on nested binomial regression models.</p>

<p><strong>RESULTS: </strong>Disparities for certain care practices such as antenatal corticosteroids and for some in-hospital outcomes have narrowed over time for minority infants. Compared with white infants, African American infants had a faster decline for mortality, hypothermia, necrotizing enterocolitis, and late-onset sepsis, whereas Hispanic infants had a faster decline for mortality, respiratory distress syndrome, and pneumothorax. Other morbidities showed a constant rate difference between African American and Hispanic versus white infants over time. Despite the improvements, outcomes including hypothermia, mortality, necrotizing enterocolitis, late-onset sepsis, and severe intraventricular hemorrhage remained elevated by the end of the study period, especially among African American infants.</p>

<p><strong>CONCLUSIONS: </strong>Racial and ethnic disparities in vital care practices and certain outcomes have decreased. That the quality deficit among minority infants occurred for several care practice measures and potentially modifiable outcomes suggests a critical role for quality improvement initiatives tailored for minority-serving hospitals.</p>

DOI

10.1542/peds.2019-1106

Alternate Title

Pediatrics

PMID

31405887

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