RESUMEN
BACKGROUND: The incidence of intraventricular hemorrhage (IVH) in very low birth weight infants can be used as an index of the quality of care in neonatal intensive care units as long as it is adjusted to reflect the infants' risk profiles on admission to the unit, which may vary systematically from one institution to another. Adjustment for gestational, birth-related, and neonatological risk factors enables a fair comparison of IVH rates across neonatal intensive care units. METHODS: Data on 1782 neonates born at less than 32 weeks of gestation or weighing less than 1500 g at birth were retrieved from the 26 744 anonymous data sets collected in the Peri- and Neonatal Survey of the German state of Saxony in the years 2001-2005. An analysis of 30 putative risk factors with stepwise logistic regression analysis enabled the construction of a specific risk predictor for severe (grade 3-4) IVH. Risk-adjusted institutional incidence rates were then calculated. RESULTS: Five independent risk factors (low gestational age, low Apgar scores at 1 min, early infection, absence of pathological Doppler findings during pregnancy, and the use of tocolytic agents) were found to be relevant to the prediction of IVH. A risk predictor incorporating them was found to have a correct prediction rate (ROC(AUC) value) of 87.7%. The crude incidence of severe IVH in different institutions ranged from 1.92% to 15.02% (mean, 8.55%); after adjustment, the range was 5.14% to 11.58%. When the institutions studied were ranked in order of their incidence of IVH before and after adjustment for risk factors, individual institutions rose or fell by as many as 4 places in the ranking because of the adjustment. CONCLUSION: These findings reveal the importance of adjusting the incidence of IVH in very low birth weight infants by the patients' risk profiles to enable valid comparisons between institutions for the purpose of quality surveillance.
Asunto(s)
Manejo de Caso/estadística & datos numéricos , Manejo de Caso/normas , Mortalidad Infantil , Enfermedades del Prematuro/mortalidad , Cuidado Intensivo Neonatal/estadística & datos numéricos , Cuidado Intensivo Neonatal/normas , Modelos de Riesgos Proporcionales , Benchmarking/métodos , Femenino , Alemania/epidemiología , Humanos , Incidencia , Recién Nacido , Recién Nacido de muy Bajo Peso , Masculino , Garantía de la Calidad de Atención de Salud/normas , Garantía de la Calidad de Atención de Salud/estadística & datos numéricos , Medición de Riesgo , Análisis de Supervivencia , Tasa de SupervivenciaRESUMEN
OBJECTIVE: The weak point of the countrywide perinatal/neonatal quality surveillance is the ignorance of interhospital differences in the case mix of patients. As a result, this approach does not produce reliable benchmarking. The objective of this study was to adjust the result of the late-onset infection incidence of different hospitals according to their risk profile of patients by multivariate analysis. METHOD: The perinatal/neonatal database of 41,055 newborns of the Saxonian quality surveillance from 1998 to 2004 was analysed. Based on 18 possible risk factors, a logistic regression model was used to develop a specific risk predictor for the quality indicator "late-onset infection". RESULTS: The developed risk predictor for the incidence of late-onset infection could be described by 4 of the 18 analysed risk factors, namely gestational age, admission from home, hypoxic ischemic encephalopathy and B-streptococcal infection. The AUC(ROC) value of this quality indicator was 83.3%, which demonstrates its reliability. The hospital ranking based on the adjusted risk assessment was very different from hospital rankings before this adjustment. The average correction of ranking position was 4.96 for 35 clinics. CONCLUSION: The application of the risk adjustment method proposed here allows for a more objective comparison of the incidence of the quality indicator "late onset infection" among different hospitals.
Asunto(s)
Benchmarking/normas , Infección Hospitalaria/epidemiología , Enfermedades del Prematuro/epidemiología , Indicadores de Calidad de la Atención de Salud/normas , Infección Hospitalaria/prevención & control , Infección Hospitalaria/transmisión , Estudios Transversales , Femenino , Alemania , Edad Gestacional , Humanos , Hipoxia-Isquemia Encefálica/complicaciones , Hipoxia-Isquemia Encefálica/epidemiología , Incidencia , Recién Nacido , Enfermedades del Prematuro/etiología , Enfermedades del Prematuro/prevención & control , Masculino , Admisión del Paciente , Embarazo , Embarazo Múltiple , Estudios Retrospectivos , Factores de Riesgo , Infecciones Estreptocócicas/epidemiología , Infecciones Estreptocócicas/prevención & control , Infecciones Estreptocócicas/transmisión , Streptococcus agalactiaeRESUMEN
OBJECTIVE: 1. The transfer rate of mature newborns will be presented as a new quality indicator. 2. Another objective of this study was to adjust the transfer rate of mature newborns of different hospitals according to their "risk" profile of patients by multivariate analysis. METHOD: The perinatal database of 118,416 newborns of the Saxonian quality surveillance from 2001 to 2004 was analysed. Based on 17 clinical and 3 structural factors, a logistic regression model was used to develop a specific "risk" predictor for the quality indicator "transfer rate". RESULTS: For care level III (basic care) a "risk" predictor for the transfer rate was developed, which consists of 15 factors. The AUC(ROC)-value of this quality indicator was 78.6%, which is sufficient. The hospital ranking based on the adjusted risk assessment was different from the hospital ranking prior to this adjustment. The average correction of ranking position was 10.4 for 43 clinics. CONCLUSION: 1. The new quality indicator "transfer rate of mature newborns" can be recommended. 2. The application of the risk adjustment method proposed here allows for a more objective comparison of the quality indicator "transfer rate" among different hospitals.