Aggregated Complication Measure for Neonatal Quality of Care

Project Number: R40 MC 05474-03
Project Date: 09/01/2005
Grantee: Children's Hospital of Philadelphia
Department/Center: Joseph Stokes, Jr. Research Institute

Final Report

Pending

Principal Investigator

Scott Andrew Lorch M.D., MSCE,
Assistant Professor, Children's Hospital of Philadelphia Joseph Stokes, Jr. Research Institute,
3615 Civic Center Boulevard
Philadelphia, PA 19104-4318
lorch@email.chop.edu

Abstract

Every year in the United States over 57,000 infants are delivered at least two months prematurely. Many of these infants are severely disabled, and their estimated cost for medical care to age 18 is between 4 and 5.4 billion dollars. A large part of these long-term costs result from complications developed after birth in the neonatal intensive care unit (NICU). While some outcomes are an unavoidable consequence of premature birth, increased cost and long-term disabilities may result from the quality of care these infants received in the NICU. However, there are no validated measures of the quality of neonatal care; currently available measures, such as mortality and individual complication rates, lack adequate power and validity and are confounded by influences outside the control o f the NICU. This study will develop and validate a new quality measure, the aggregate complication measure (ACM), to evaluate hospitals according to the quality of care they provide after using direct standardization methods to control for differences in casemix. This study will use population data from Pennsylvania, New York, and California, with an estimated 95,000 premature births each year. Statistical modeling techniques will determine valid weights for each complication based on the impact of each complication on one of four outcomes of interest: death, length of stay, cost, or 28-day readmissions. This project fulfills MCH Strategic Research Issues III, "Systems to assure quality of care for MCH populations" by giving policy makers a validated method of assessing and assuring the quality of neonatal care at individual hospitals. Additionally, this project fulfills MCH Strategic Research Issue I, "Public health service systems and infrastructures at the community, state, and/or national levels, as they apply to different maternal and child health populations based on demographic, epidemiological, and/or other factors" by determining the optimal location of care for different populations of high-risk infants. Completion of this project will produce a valid measure of neonatal quality to both evaluate hospitals and quantify the difference in quality between hospitals. Improved measures of neonatal quality will help facilitate initiatives to lower costs and improve the quality of neonatal care by reducing unnecessary morbidity and mortality in these infants.

Publications

Listed is descending order by year published.

Lorch, SA, Wade, KC, Bakewell-Sachs, S, Medoff-Cooper, B, Escobar, G, Silber, J, Racial Differences in the Use of Respiratory Medications in Premature Infants after Discharge from the Neonatal Intensive Care Unit, The Journal of Pediatrics, December 2007, 604-610.

Keywords

premature infants, quality of care, neonatal complications, cost of medical care