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Does provider access to technology improve health care? Evidence from a national distribution of phototherapy in
Ketki Sheth1, Lisine Tuyisenge2, Vinod K Bhutani3
1Department of Economics, University of California, 5200 N. Lake Road, Merced, CA 95343, United States.
Insights
Providing phototherapy (PT) devices to hospitals improved infant jaundice care, increasing PT use and decreasing sunlight use. However, improved diagnosis and bilirubin monitoring are needed to maximize PT benefits.
Area of Science:
- Neonatal Medicine
- Public Health Interventions
- Healthcare Delivery
Background:
- Severe hyperbilirubinemia poses risks to infants.
- Access to effective phototherapy (PT) is crucial for managing infant jaundice.
- National distribution of PT devices aims to improve care for at-risk infants.
Purpose of the Study:
- To assess the causal effect of a national phototherapy device distribution on infant jaundice care practices.
- To evaluate changes in treatment modalities, including PT, sunlight, and standard PT, following device availability.
Main Methods:
- Utilized healthcare data for infants diagnosed with jaundice.
- Employed a randomized roll-out of PT devices to estimate intervention effects.
- Analyzed changes in care practices pre- and post-intervention.
Main Results:
- Hospitals with PT devices saw a 6.26 pp increase in PT use for jaundiced infants.
- Sunlight and standard PT use decreased by 6.96 pp and 14.0 pp, respectively.
- The intervention did not improve the low infant jaundice diagnosis rate.
Conclusions:
- National distribution of PT devices enhances appropriate treatment for infant jaundice.
- Complementary investments in jaundice diagnosis and bilirubin monitoring are essential.
- Improving diagnostic accuracy will amplify the benefits of expanded PT device access.
Abstract:
This study assessed a large-scale national distribution of phototherapy (PT) for infants at risk for severe hyperbilirubinemia. We combined healthcare data for infants with jaundice (using local clinical definitions) with a randomized roll-out of PT devices to estimate the causal effect of the national distribution. Pre-intervention, <3.0% of infants were diagnosed as jaundiced, 41.7% of these infants were not tested for bilirubin, and 17.5% and 34.3% were treated with direct sunlight or standard PT, respectively. We found that providing hospitals with PT devices increased care practices: infants with jaundice were more likely to receive PT [+6.26 percentage points (pp)], and less likely to receive sunlight (-6.96 pp) or standard (irradiance < 30 µW/cm2/nm) PT (-14.0 pp). However, the intervention did not affect the low diagnosis rate. Our findings suggest that complementary investments in improving diagnosis and monitoring of bilirubin levels increases the benefits of expanding provider access to PT devices.
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