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Regional variation in antenatal corticosteroid use: a network-level quality improvement study.
J Profit1, B A Goldstein2, J Tamaresis3
1Perinatal Epidemiology and Health Outcomes Research Unit, Division of Neonatology, Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children's Hospital, Palo Alto, California; California Perinatal Quality Care Collaborative, Palo Alto, California; profit@stanford.edu.
Pediatrics
|January 21, 2015
Summary
Significant variation in antenatal corticosteroid use (ACU) exists across California perinatal regions. Lower-performing regions showed greater variability, suggesting a need for regional quality improvement to spread best practices in ACU.
Area of Science:
- Perinatal care quality
- Neonatal health outcomes
- Healthcare delivery systems
Background:
- Antenatal corticosteroid use (ACU) is crucial for improving outcomes in preterm infants.
- Regional variations in ACU may reflect differences in care quality and access.
- Understanding these variations is key to developing targeted interventions.
Purpose of the Study:
- To assess network-level variation in antenatal corticosteroid use (ACU) rates across California perinatal care regions.
- To test the hypothesis that significant variation in ACU exists within and between regions.
- To determine if lower-performing regions have greater NICU-level variability in ACU.
Main Methods:
- Cross-sectional analysis of 33,610 very low birth weight infants from 120 hospitals in 11 California perinatal regions (2005-2011).
- Risk-adjusted median ACU rates and interquartile ranges (IQR) were computed for each region.
- Hierarchical multivariate regression analysis was used to assess the degree of variation.
Main Results:
- Mean ACU rates in California increased from 82% to 87.9% between 2005 and 2011.
- Significant variation in ACU rates was observed among regions (P < .0001), with regional medians ranging from 68.4% to 92.9%.
- Lower NICU levels of care were associated with significantly lower odds of receiving ACU, and lower-performing regions showed greater variability.
Conclusions:
- Significant variation in antenatal corticosteroid use exists among California perinatal regions.
- Regional quality improvement initiatives may be effective in disseminating best practices for ACU.
- Addressing regional disparities in ACU is essential for improving neonatal outcomes.
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