Neonatal Health Services
The Children's Hospital of Philadelphia is a national leader in care for neonates and neonatal health services research. Currently, neonatal and perinatal health services research at the Center for Outcomes Research focuses on three areas, all designed to answer questions about the underlying causes of variations in the outcomes and health care use of children. These areas include socioeconomic status, specifically racial/ethnic identification; the quality of care at the treatment hospital and outpatient center; and the health care system. Analyses occur at the patient level, public health level, and population level using population-based data to answer these questions. COR has experience using state-based maternal-newborn linked data, which link birth and death certificates to hospital data from the mother and child (over 10 million observations in a 15 year period); the Pediatric Hospital Inpatient System from CHCA; National Medicaid data; and Medicare records. COR also has experience with the development and maintenance of longitudinal cohorts of prematurely-born infants.Listed below are ongoing or completed research projects conducted by by center investigators that focus on neonatal and perinatal health services.
Parental Trust and Racial Disparities in the Care of Discharged Premature Infants
Racial disparities continue to be a major impediment to the delivery of high quality health care to all patients. This study is examining various underlying explanations for such disparities in the outcomes of care provided to premature infants in the first two years after discharge from the neonatal intensive care unit. By understanding these underlying explanations for the racial disparities in these outcomes, particularly families’ trust in the health care system, we can aid in the development of interventions to reduce these differences in care.
The Financing of Obstetrical Care in the U.S.
Predicting and Preventing Pediatric Hospital Readmissions
The prevention of hospital readmissions, particularly preventable or unnecessary readmissions, has become an area of interest for public policy makers, health insurers, and providers. Medicare has begun a readmission reduction program to reduce payments to hospitals with higher-than-expected readmission rates. A similar interest is seen in pediatric medicine. While the estimated readmission rate within 30 days among the 2.4 million admissions annually in the United States is approximately 6.5%, many conditions such as surgery, sickle cell disease, and prematurity have rates between 15 and 20%. Children with publicly-financed insurance have higher rates of readmission, with rates of prematurely-born infants in some states as high as 30%. Most methods to predict the risk of readmission for both adult and pediatric patients frequently misclassify patients, thus the principal goal of this study is to develop a real-time predictor of readmission risk for pediatric patients.
Recently Completed Projects
Impact of Obstetric Unit Closures on Pregancy Outcomes
Although over 4 million infants are delivered in the United States every year, the reduction of obstetric services through the closure of obstetric units is a common occurrence. This study is investigating the impact of obstetric unit closures on the pregnancy outcomes of both the larger community and the smaller community serviced by the closed obstetric unit. Improved understanding of the impact of such service reductions in the obstetric market will result in more efficient use of health care services and optimize the value of health care dollars spent on obstetric care.
Evaluating Maternal and Neonatal Outcomes
Over 4 million women give birth annually in the United States, making child birth one of the most common reasons for hospital care. Provider and nurse staffing structure on labor and delivery units have recently received heightened attention as critical aspects of obstetric care delivery. Prior to the widespread adoption of specific staffing models, rigorous research is needed to study the impact these structural aspects of obstetric care. This project was evaluating structural aspects of obstetric care and their impact on processes of care and resultant maternal and neonatal outcomes.
Scope of Services for Fetal Mortality: Epidemiology and Performance Measurement
Neonatal mortality rates have been proposed as a measure of the quality of neonatal care. There has been little validation of the correct metric for their use. The purpose of this project was to calculate several separate hospital mortality statistics to characterize fetal deaths and determine the importance of fetal deaths when using mortality as a measure of the performance of neonatal or perinatal care.
Perinatal Regionalization and Quality of Care
Very-low-birth weight a significant public health concern. Regionalization policies have been developed to optimize the care of these high-risk newborns, but these policies have recently weakened in many areas of the U.S. This study used an instrumental variables approach to evaluate differences in quality of care between hospitals and the effect of de-regionalization on outcomes.
Infant Functional Status and Discharge Management
This project developed a more optimal algorithm to support infant discharge decisions, based on the relationship between physiologic parameters reflecting infant functional status and total resource utilization associated with these discharge decisions. The main hypothesis tested was whether there exists a range of discharge algorithms in which longer hospital stays may result in reduced overall resource utilization.
Aggregated Complication Measure for Neonatal Quality of Care
Improved measures of neonatal quality will help facilitate initiatives to lower costs and improve the quality of neonatal care by reducing unnecessary morbidity and mortality in these infants. This study developed and validated a new quality measure, the aggregate complication measure (ACM), to evaluate hospitals according to the quality of care they provide after using direct standardization methods to control for differences in casemix.
The Impact of Physiological Maturation of the Premature Infant on Perinatal Outcomes
The goals of this project were to determine the rate of physiological maturation of premature infants in those skills necessary for discharge to home (degree of respiratory support, control of breathing, coordination of feeding, ability to gain weight and control of core body temperature); (2) identify the relationship between the attainment of these skills and the short- and long-term outcome measures of 1-, 3- and 12-month readmission, total cost of medical care and use of emergency room services; and (3) validate a function maturity score to assist clinicians in optimizing the timing of discharge of premature infants.