Intensive care supply and admission decisions

Area of Science:

• Neonatal Medicine
• Health Services Research
• Health Economics

Background:

• Significant expansion of neonatal intensive care units (NICUs) and beds occurred between 2005-2019.
• This growth raises concerns about potentially unnecessary admissions to intensive care.
• Understanding the causal impact of NICU supply on admission rates is crucial.

Purpose of the Study:

• To investigate whether an increased supply of NICUs causally influences neonatal intensive care admission rates.
• To differentiate the impact of NICU supply on admissions based on newborn health status and prematurity.
• To assess the effect of NICU supply on neonatal mortality, particularly for vulnerable infants.

Main Methods:

• Utilized an event-study methodology to analyze the causal relationship between NICU openings and admission trends.
• Examined admission data, stratifying by newborn weight (e.g., <1,500 grams vs. ≥2,500 grams).
• Assessed mortality rates in relation to NICU supply, focusing on different infant subgroups.

Main Results:

• The opening of an additional NICU in a county increased the overall NICU admission rate by 8%.
• The majority of increased admissions were for healthier, larger newborns (≥2,500 grams).
• Admission rates for the smallest infants (<1,500 grams) only rose in areas with previously limited NICU access.
• Greater NICU supply reduced mortality, but exclusively for very small newborns (<1,500 grams).

Conclusions:

• Higher NICU supply leads to increased admissions of healthier newborns, indicating potential overuse.
• A significant benefit of increased NICU supply is reduced mortality among the most vulnerable neonates.
• There is a complex tradeoff between expanding NICU access for improved outcomes in high-risk infants and potential over-admission of lower-risk infants.