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Hospital variation in extremely preterm birth.

Gregory P Goldstein1, Peiyi Kan2, Ciaran S Phibbs2,3

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Extremely preterm birth rates vary significantly between hospitals, even when accounting for care level and patient factors. These variations highlight areas for quality improvement in neonatal care.

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Area of Science:

  • Neonatalogy
  • Perinatal Epidemiology
  • Healthcare Quality Improvement

Background:

  • Regionalization of extremely preterm births (EPTBs) is linked to better infant outcomes.
  • Understanding variations in EPTB rates across hospitals is crucial for improving care.
  • Identifying factors contributing to these variations can guide targeted interventions.

Purpose of the Study:

  • To assess hospital-level variation in extremely preterm births (EPTBs).
  • To stratify EPTB rates by hospital neonatal care level.
  • To determine the influence of maternal and hospital factors on EPTB rates.

Main Methods:

  • Analysis of 7,046,253 births in California (1997-2011) using linked birth, death, and hospital discharge data.
  • Multivariable regression to estimate associations between maternal/hospital factors and EPTB.
  • Calculation of hospital-specific EPTB frequencies and between-hospital variances, stratified by neonatal care level.

Main Results:

  • Hospital EPTB frequencies ranged from 0% to 2.5%.
  • Significant between-hospital variation in EPTB rates persisted after stratification by care level and adjustment for confounders.
  • Differences were observed among hospitals with Level 1 and Level 2 neonatal care.

Conclusions:

  • Substantial differences in extremely preterm birth rates exist among hospitals, particularly those with Level 1 and 2 neonatal care.
  • These findings indicate specific areas for future research and quality improvement initiatives in perinatal care.
  • Targeting quality improvement efforts at hospitals with varying neonatal care levels may reduce EPTB disparities.