Neonatal Intensive Care Variation in Medicaid-Insured Newborns: A Population-Based Study.

Area of Science:

• Neonatalogy
• Health Services Research
• Healthcare Economics

Background:

• Neonatal intensive care unit (NICU) utilization varies significantly across geographic regions and healthcare facilities.
• Understanding the drivers of this variation is crucial for optimizing resource allocation and ensuring equitable, high-quality care for newborns.

Purpose of the Study:

• To evaluate the extent to which maternal and newborn characteristics explain variations in NICU use among different regions and hospitals.
• To analyze the association between infant illness severity and NICU resource utilization.

Main Methods:

• Retrospective analysis of a population-based live birth cohort of Texas Medicaid-insured infants from 2010-2014.
• Subcohorts included very low birth weight (VLBW) and late preterm singletons.
• Calculated NICU admission rates, special care days, and imaging procedures, with and without health risk adjustment, across 21 Neonatal Intensive Care Regions and 100 hospitals.

Main Results:

• While VLBW infant NICU admissions showed little regional variation, late preterm infants exhibited marked variation in NICU admissions, special care days, and imaging rates.
• Risk adjustment only slightly reduced the observed variations.
• A moderate substitution between intensive and intermediate care days was noted across hospitals for both VLBW and late preterm infants.

Conclusions:

• Differences in newborn illness levels poorly explained the observed variations in NICU use.
• Varying practice styles among clinicians and hospitals are likely the primary drivers of these disparities.
• The current patterns of NICU utilization suggest that not all care is effective or efficient, highlighting a need for practice standardization.