Horizontally integrated health systems and neonatal intensive care unit (NICU) care for very preterm infants

Area of Science:

• Pediatric Healthcare Delivery
• Health Systems Research
• Neonatal Care

Background:

• Infants born very preterm represent a vulnerable pediatric population and a significant cause of infant mortality.
• The healthcare delivery for newborns is unique, involving both mother and infant during birth hospitalization.
• Regionalization of care for preterm infants necessitates specialized Neonatal Intensive Care Units (NICUs).

Purpose of the Study:

• To analyze the impact of hospital consolidation on the care of very preterm infants.
• To investigate the role of horizontally integrated health systems in managing preterm infant hospitalizations.
• To assess the implications of high transfer rates within health systems for care quality and patient-centeredness.

Main Methods:

• Utilized national patient-level data from the Vermont Oxford Network.
• Analyzed hospitalization patterns of very preterm infants within multi-hospital systems.
• Examined the proportion of infants within different sizes and types of health systems.

Main Results:

• 84% of very preterm infants were born within horizontally integrated, multi-hospital systems.
• Most infants remained within their birth system for the entirety of their hospitalization, including NICU care.
• 21% of infants experienced inter-hospital transfers, with half cared for in systems exceeding 10 hospitals, often cross-market systems.

Conclusions:

• Hospital consolidation is prevalent in the care of very preterm infants, with most receiving care within large, integrated systems.
• The high rate of transfers within systems warrants further investigation into its effects on care quality and family experience.
• Understanding these system dynamics is vital given the significant healthcare costs and policy implications associated with newborn hospitalizations.