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Published on: January 12, 2018
Prioritization framework for improving the value of care for very low birth weight and very preterm infants
Brian C King1, Troy Richardson2, Ravi M Patel3
1Department of Pediatrics, Section of Neonatology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA. bcking@bcm.edu.
Insights
This study developed a prioritization framework to improve neonatal care value. Parenteral nutrition emerged as the top priority for quality improvement efforts in caring for premature and low birth weight infants.
Area of Science:
- Neonatal Medicine
- Healthcare Management
- Health Services Research
Background:
- Neonatal intensive care units (NICUs) face increasing pressure to improve value-based care.
- Identifying key areas for resource optimization is crucial for enhancing patient outcomes and reducing costs.
- Previous efforts have not systematically prioritized interventions for value-based improvement in neonatal populations.
Purpose of the Study:
- To develop and apply a novel prioritization framework for identifying areas of high potential for value-based improvement in neonatal care.
- To guide resource allocation and quality improvement initiatives within neonatal settings.
- To establish a data-driven approach for ranking resource categories based on cost, patient exposure, and inter-hospital variability.
Main Methods:
- Retrospective cohort study utilizing the Pediatric Health Information System Database (2012-2019).
- Inclusion of very low birth weight (<1500g) and/or very preterm (<32 weeks) infants.
- Development of a prioritization score combining cost, patient exposure, and inter-hospital variability to rank resource categories.
Main Results:
- Parenteral nutrition demonstrated the highest overall priority score.
- Hematology (laboratory testing) and anticoagulation (for central venous access and therapy) were identified as significant resource categories.
- Significant inter-hospital variability was observed in resource utilization.
Conclusions:
- A robust prioritization framework for value-based neonatal care improvement has been established.
- Parenteral nutrition represents a key area for immediate quality improvement efforts.
- Central venous access, high-volume laboratory, and imaging modalities are also recommended priorities for future research and interventions.
Objective:
Create a prioritization framework for value-based improvement in neonatal care.
Study Design:
A retrospective cohort study of very low birth weight (<1500 g) and/or very preterm (<32 weeks) infants discharged between 2012 and 2019 using the Pediatric Health Information System Database. Resource use was compared across hospitals and adjusted for patient-level differences. A prioritization score was created combining cost, patient exposure, and inter-hospital variability to rank resource categories.
Results:
Resource categories with the greatest cost, patient exposure, and inter-hospital variability were parenteral nutrition, hematology (lab testing), and anticoagulation (for central venous access and therapy), respectively. Based on our prioritization score, parenteral nutrition was identified as the highest priority overall.
Conclusions:
We report the development of a prioritization score for potential value-based improvement in neonatal care. Our findings suggest that parenteral nutrition, central venous access, and high-volume laboratory and imaging modalities should be priorities for future comparative effectiveness and quality improvement efforts.
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