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Published on: April 7, 2023
Effect of newborn screening for critical CHD on healthcare utilisation
Rie Sakai-Bizmark1,2, Hiraku Kumamaru3, Eliza J Webber1
1Department of Pediatrics, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, USA.
Insights
State-mandated pulse oximetry screening policies reduced false-positive hypoxemia diagnoses in newborns. These policy impacts were primarily observed among non-White infants, indicating improved screening accuracy.
Area of Science:
- Neonatal screening
- Public health policy
- Healthcare utilization
Background:
- Pulse oximetry screening is used to detect critical congenital heart defects (critical CHD) in newborns.
- State mandates for pulse oximetry screening aim to improve early detection and reduce healthcare costs.
Purpose of the Study:
- To evaluate the impact of state-mandated pulse oximetry screening policies on healthcare utilization, specifically echocardiogram use.
- To assess changes in the rate of newborns undergoing echocardiograms for suspected hypoxemic conditions.
Main Methods:
- Utilized Healthcare Cost and Utilisation Project, Statewide Inpatient Databases (2008-2014) from six states.
- Employed interrupted time series analysis with segmented regression to compare pre- and post-mandate periods.
- Analyzed trends in critical CHD-negative echocardiograms and echocardiograms without identified hypoxemic causes.
Main Results:
- No significant overall change in the rate of critical CHD-negative echocardiograms was detected post-mandate.
- An increasing trend in critical CHD-negative echocardiograms pre-mandate was observed, which was attenuated post-mandate (IRR: 0.93, p=0.14).
- Reductions in false-positive screening rates were primarily driven by trends among non-White infants.
Conclusions:
- Mandatory pulse oximetry screening policies are associated with decreased false-positive rates for hypoxemic conditions.
- The positive impact on screening accuracy was more pronounced among non-White newborns.
- Policies may improve the specificity of newborn screening for critical CHD.
Objective:
To evaluate the impact of state-mandated policies for pulse oximetry screening on healthcare utilisation, with a focus on use of echocardiograms.
Data Sources/Study Setting:
Healthcare Cost and Utilisation Project, Statewide Inpatient Databases from 2008 to 2014 from six states.
Methods:
We defined pre- and post-mandate cohorts based on dates when pulse oximetry became mandated in each state. Linear segmented regression models for interrupted time series assessed associations between implementation of the screening and changes in rate of newborns with Critical CHD-negative echocardiogram results. We also evaluated the changes in rate of newborns who underwent echocardiogram but were not diagnosed with any health issues that could cause hypoxemia.
Results:
We identified 5967 critical CHD-negative echocardiograms (2847 and 3120 in the pre- and post-mandate periods, respectively). Our models detected a statistically significant increasing trend in rate of critical CHD-negative echocardiograms in the pre-mandate period (Incidence Rate Ratio: 1.08, p = 0.02), but did not detect any statistical differences in changes between pre- and post-mandate periods (Incidence Rate Ratio: 0.93, p = 0.14). Among non-Whites, an increasing trend of Critical CHD-negative echocardiogram during the pre-mandate period was detected (Incidence Rate Ratio 1.12, p < 0.01) and was attenuated during the post-mandate period (Incidence Rate Ratio 0.89, p = 0.02). Similar results were observed in the sensitivity analyses among both Whites and non-Whites.
Conclusions:
Results suggest that mandatory state screening policies are associated with reductions in false-positive screening rates for hypoxemic conditions, with reductions primarily attributed to trends among non-Whites.
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