Variation in Neonatal Intensive Care and Post-Discharge Outcomes in Military-Insured Newborns

Neonatal care, including intensive care, varies across health care regions. This study measured regional risk-adjusted use of military-insured newborn care and associations with 7-day post-discharge hospital care.

A total of 420 175 live births to military-insured TRICARE beneficiaries, from October 1, 2015 through December 31, 2020, were assigned to regional catchment areas (n = 103) based on birth location. Administrative records provided sponsor/parental/newborn factors associated with neonatal mortality that were used to adjust regional neonatal intensive care unit (NICU) use rates. The associations of these rates and 7-day post-discharge hospital care were estimated with weighted Pearson and Spearman coefficients.

Adjusted regional NICU admission rates and numbers of special care days (SCDs) generally varied little for very preterm (VPT) and moderate preterm (MPT) newborns (coefficients of variation [CVs; SD/mean]<10). Regional variation was high for all types of use in late preterm (LPT) and nonpreterm (NPT) newborns (CVs generally >20). Associations between regional NICU admission and 7-day discharge events were weakly negative for LPT (weighted Pearson correlation coefficient, -0.42; 95% CI, -0.56 to -0.25; R2 0.17) and NPT (-0.35; 95% CI, -0.49 to -0.20; R2 0.12) newborns. Correlation coefficients between NICU admission rates and 7-day post-discharge events for VPT and MPT newborns and for the number of SCDs across all subcohorts were not statistically significant. Similar correlations were observed for 30- and 90-day post-discharge outcomes.

Regional variation in NICU use was high for LPT and NPT newborns in both military and civilian hospitals and had weak or unassociated risk of post-hospital care.