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

Area of Science:

• Neonatal care research
• Health services research
• Pediatric intensive care

Background:

• Neonatal intensive care unit (NICU) utilization exhibits regional disparities.
• Understanding variations in newborn care is crucial for optimizing resource allocation and patient outcomes.
• Military healthcare systems provide a unique population for studying regional variations in care.

Purpose of the Study:

• To measure regional risk-adjusted use of neonatal intensive care for military-insured newborns.
• To assess the association between regional NICU use patterns and subsequent 7-day post-discharge hospital care.
• To identify variations in neonatal care across different health care regions.

Main Methods:

• Analysis of 420,175 live births to TRICARE beneficiaries (Oct 2015-Dec 2020).
• Assignment of newborns to 103 regional catchment areas based on birth location.
• Risk adjustment for NICU use rates using demographic and clinical factors; estimation of associations with post-discharge care using weighted correlation coefficients.

Main Results:

• High regional variation (CVs >20) in NICU use for late preterm (LPT) and non-preterm (NPT) newborns.
• Low regional variation (CVs <10) for very preterm (VPT) and moderate preterm (MPT) newborns.
• Weak negative associations between regional NICU admission rates and 7-day post-discharge events for LPT and NPT newborns; no significant associations for VPT/MPT or special care days.

Conclusions:

• Significant regional variation exists in NICU utilization for LPT and NPT newborns within the military healthcare system.
• Observed regional variations in NICU use demonstrated a weak or no association with the risk of post-hospital care.
• Findings suggest potential for standardization of care, particularly for LPT and NPT populations.