PDF(Pubmed)
Abstract：
UNASSIGNED: The Joint Commission Unexpected Complications in Term Newborns measure characterizes newborn morbidity potentially associated with quality of labor and delivery care. Infant exclusions isolate relatively low-risk births, but unexpected newborn complications (UNCs) are not adjusted for maternal factors that may be associated with outcomes independently of hospital quality.
UNASSIGNED: To investigate the association between maternal characteristics and hospital UNC rates.
UNASSIGNED: This cohort study was conducted using linked 2016 to 2018 New York City birth and hospital discharge datasets among 254 259 neonates at low risk (singleton, ≥37 weeks, birthweight ≥2500 g, and without preexisting fetal conditions) at 39 hospitals. Logistic regression was used to calculate unadjusted hospital-specific UNC rates and replicated analyses adjusting for maternal covariates. Hospitals were categorized into UNC quintiles; changes in quintile ranking with maternal adjustment were examined. Data analyses were performed from December 2022 to July 2023.
UNASSIGNED: UNCs were classified according to Joint Commission International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) criteria. Maternal preadmission comorbidities, obstetric factors, social characteristics, and hospital characteristics were ascertained.
UNASSIGNED: Among 254 259 singleton births at 37 weeks or later who were at low risk (125 245 female [49.3%] and 129 014 male [50.7%]; 71 768 births [28.2%] to Hispanic, 47 226 births [18.7%] to non-Hispanic Asian, 42 682 births [16.8%] to non-Hispanic Black, and 89 845 births [35.3%] to non-Hispanic White mothers and 2738 births [1.0%] to mothers with another race or ethnicity), 148 393 births (58.4%) were covered by Medicaid and 101 633 births (40.0%) were covered by commercial insurance. The 2016 to 2018 cumulative UNC incidence in New York City hospitals was 37.1 UNCs per 1000 births. Infants of mothers with preadmission risk factors had increased UNC risk; for example, among mothers with vs without preeclampsia, there were 104.4 and 35.8 UNCs per 1000 births, respectively. Among hospitals, unadjusted UNC rates ranged from 15.6 to 215.5 UNCs per 1000 births and adjusted UNC rates ranged from 15.6 to 194.0 UNCs per 1000 births (median [IQR] change from adjustment, 1.4 [-4.7 to 1.0] UNCs/1000 births). The median (IQR) change per 1000 births for adjusted vs unadjusted rates showed that hospitals with low (<601 deliveries/year; -2.8 [-7.0 to -1.6] UNCs) to medium (601 to <954 deliveries/year; -3.9 [-7.1 to -1.9] UNCs) delivery volume, public ownership (-3.6 [-6.2 to -2.3] UNCs), or high proportions of Medicaid-insured (eg, ≥90.72%; -3.7 [-5.3 to -1.9] UNCs), Black (eg, ≥32.83%; -5.3 [-9.1 to -2.2] UNCs), or Hispanic (eg, ≥6.25%; -3.7 [-5.3 to -1.9] UNCs) patients had significantly decreased UNC rates after adjustment, while rates increased or did not change in hospitals with the highest delivery volume, private ownership, or births to predominantly White or privately insured individuals. Among all 39 hospitals, 7 hospitals (17.9%) shifted 1 quintile comparing risk-adjusted with unadjusted quintile rankings.
UNASSIGNED: In this study, adjustment for maternal case mix was associated with small overall changes in hospital UNC rates. These changes were associated with performance assessment for some hospitals, and these results suggest that profiling on this measure should consider the implications of small changes in rates for hospitals with higher-risk obstetric populations.
UNASSIGNED: To investigate the association between maternal characteristics and hospital UNC rates.
UNASSIGNED: This cohort study was conducted using linked 2016 to 2018 New York City birth and hospital discharge datasets among 254 259 neonates at low risk (singleton, ≥37 weeks, birthweight ≥2500 g, and without preexisting fetal conditions) at 39 hospitals. Logistic regression was used to calculate unadjusted hospital-specific UNC rates and replicated analyses adjusting for maternal covariates. Hospitals were categorized into UNC quintiles; changes in quintile ranking with maternal adjustment were examined. Data analyses were performed from December 2022 to July 2023.
UNASSIGNED: UNCs were classified according to Joint Commission International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) criteria. Maternal preadmission comorbidities, obstetric factors, social characteristics, and hospital characteristics were ascertained.
UNASSIGNED: Among 254 259 singleton births at 37 weeks or later who were at low risk (125 245 female [49.3%] and 129 014 male [50.7%]; 71 768 births [28.2%] to Hispanic, 47 226 births [18.7%] to non-Hispanic Asian, 42 682 births [16.8%] to non-Hispanic Black, and 89 845 births [35.3%] to non-Hispanic White mothers and 2738 births [1.0%] to mothers with another race or ethnicity), 148 393 births (58.4%) were covered by Medicaid and 101 633 births (40.0%) were covered by commercial insurance. The 2016 to 2018 cumulative UNC incidence in New York City hospitals was 37.1 UNCs per 1000 births. Infants of mothers with preadmission risk factors had increased UNC risk; for example, among mothers with vs without preeclampsia, there were 104.4 and 35.8 UNCs per 1000 births, respectively. Among hospitals, unadjusted UNC rates ranged from 15.6 to 215.5 UNCs per 1000 births and adjusted UNC rates ranged from 15.6 to 194.0 UNCs per 1000 births (median [IQR] change from adjustment, 1.4 [-4.7 to 1.0] UNCs/1000 births). The median (IQR) change per 1000 births for adjusted vs unadjusted rates showed that hospitals with low (<601 deliveries/year; -2.8 [-7.0 to -1.6] UNCs) to medium (601 to <954 deliveries/year; -3.9 [-7.1 to -1.9] UNCs) delivery volume, public ownership (-3.6 [-6.2 to -2.3] UNCs), or high proportions of Medicaid-insured (eg, ≥90.72%; -3.7 [-5.3 to -1.9] UNCs), Black (eg, ≥32.83%; -5.3 [-9.1 to -2.2] UNCs), or Hispanic (eg, ≥6.25%; -3.7 [-5.3 to -1.9] UNCs) patients had significantly decreased UNC rates after adjustment, while rates increased or did not change in hospitals with the highest delivery volume, private ownership, or births to predominantly White or privately insured individuals. Among all 39 hospitals, 7 hospitals (17.9%) shifted 1 quintile comparing risk-adjusted with unadjusted quintile rankings.
UNASSIGNED: In this study, adjustment for maternal case mix was associated with small overall changes in hospital UNC rates. These changes were associated with performance assessment for some hospitals, and these results suggest that profiling on this measure should consider the implications of small changes in rates for hospitals with higher-risk obstetric populations.
摘要：
■联合委员会在足月新生儿中的意外并发症测量表征了与分娩质量和分娩护理潜在相关的新生儿发病率。婴儿排除隔离相对低风险的分娩，但意外新生儿并发症(UNCs)未针对可能与预后相关的产妇因素进行校正,而不考虑医院质量.
■调查产妇特征与医院UNC发生率之间的关系。
■这项队列研究是使用2016年至2018年纽约市出生和出院数据集进行的，该数据集涉及254259名低风险新生儿（单例，≥37周，出生体重≥2500g，并且没有先前存在的胎儿状况）在39家医院。Logistic回归用于计算未调整的医院特异性UNC率和重复分析，以调整母体协变量。将医院分为UNC五分位数；检查了母亲调整后五分位数排名的变化。数据分析于2022年12月至2023年7月进行。
■根据联合委员会国际疾病和相关健康问题统计分类，第十次修订(ICD-10)标准。产妇入院前合并症，产科因素，社会特征,并确定了医院的特点。
■在37周或更晚的254259例单胎新生儿中，低风险（125245例女性[49.3％]和129014例男性[50.7％]；71768例出生[28.2％]西班牙裔，非西班牙裔亚洲人出生47226例[18.7%]，非西班牙裔黑人出生42682例[16.8%]，非西班牙裔白人母亲为89845例[35.3%]，其他种族或族裔母亲为2738例[1.0%]），医疗补助覆盖了148393例（58.4％），商业保险覆盖了101633例（40.0％）。纽约市医院2016年至2018年的累积UNC发病率为每1000名新生儿37.1名UNC。具有入院前风险因素的母亲的婴儿增加了UNC风险；例如，在没有先兆子痫的母亲中，每1000名新生儿有104.4和35.8个UNC，分别。在医院中，未调整的UNC比率为每1000名新生儿15.6至215.5UNC，调整后的UNC比率为每1000名新生儿15.6至194.0UNC(调整后的[IQR]中位数变化，1.4[-4.7至1.0]UNC/1000出生)。调整后的比率与未调整后的比率的每1000名新生儿的中位数（IQR）变化表明，低（<601分娩/年；-2.8[-7.0至-1.6]UNC）至中（601至<954分娩/年；-3.9[-7.1至-1.9]UNC）分娩量的医院，公有制(-3.6[-6.2至-2.3]个UNC)，或高比例的医疗补助保险(例如，≥90.72%；-3.7[-5.3至-1.9]个UNC)，黑色(例如，≥32.83%；-5.3[-9.1至-2.2]个UNC)，或西班牙裔(例如，≥6.25%；-3.7[-5.3至-1.9]UNCs)患者在调整后UNC率显著下降，虽然分娩量最高的医院的发病率增加或没有变化，私有制,或出生到主要是白人或私人保险的个人。在所有39家医院中，7家医院（17.9%）将风险调整后的五分之一排名与未调整的五分之一排名进行了比较。
■在这项研究中，产妇病例组合的校正与医院UNC比率的总体变化较小相关.这些变化与一些医院的绩效评估有关，这些结果表明,对这一措施的分析应考虑死亡率的微小变化对产科高危人群医院的影响.
■调查产妇特征与医院UNC发生率之间的关系。
■这项队列研究是使用2016年至2018年纽约市出生和出院数据集进行的，该数据集涉及254259名低风险新生儿（单例，≥37周，出生体重≥2500g，并且没有先前存在的胎儿状况）在39家医院。Logistic回归用于计算未调整的医院特异性UNC率和重复分析，以调整母体协变量。将医院分为UNC五分位数；检查了母亲调整后五分位数排名的变化。数据分析于2022年12月至2023年7月进行。
■根据联合委员会国际疾病和相关健康问题统计分类，第十次修订(ICD-10)标准。产妇入院前合并症，产科因素，社会特征,并确定了医院的特点。
■在37周或更晚的254259例单胎新生儿中，低风险（125245例女性[49.3％]和129014例男性[50.7％]；71768例出生[28.2％]西班牙裔，非西班牙裔亚洲人出生47226例[18.7%]，非西班牙裔黑人出生42682例[16.8%]，非西班牙裔白人母亲为89845例[35.3%]，其他种族或族裔母亲为2738例[1.0%]），医疗补助覆盖了148393例（58.4％），商业保险覆盖了101633例（40.0％）。纽约市医院2016年至2018年的累积UNC发病率为每1000名新生儿37.1名UNC。具有入院前风险因素的母亲的婴儿增加了UNC风险；例如，在没有先兆子痫的母亲中，每1000名新生儿有104.4和35.8个UNC，分别。在医院中，未调整的UNC比率为每1000名新生儿15.6至215.5UNC，调整后的UNC比率为每1000名新生儿15.6至194.0UNC(调整后的[IQR]中位数变化，1.4[-4.7至1.0]UNC/1000出生)。调整后的比率与未调整后的比率的每1000名新生儿的中位数（IQR）变化表明，低（<601分娩/年；-2.8[-7.0至-1.6]UNC）至中（601至<954分娩/年；-3.9[-7.1至-1.9]UNC）分娩量的医院，公有制(-3.6[-6.2至-2.3]个UNC)，或高比例的医疗补助保险(例如，≥90.72%；-3.7[-5.3至-1.9]个UNC)，黑色(例如，≥32.83%；-5.3[-9.1至-2.2]个UNC)，或西班牙裔(例如，≥6.25%；-3.7[-5.3至-1.9]UNCs)患者在调整后UNC率显著下降，虽然分娩量最高的医院的发病率增加或没有变化，私有制,或出生到主要是白人或私人保险的个人。在所有39家医院中，7家医院（17.9%）将风险调整后的五分之一排名与未调整的五分之一排名进行了比较。
■在这项研究中，产妇病例组合的校正与医院UNC比率的总体变化较小相关.这些变化与一些医院的绩效评估有关，这些结果表明,对这一措施的分析应考虑死亡率的微小变化对产科高危人群医院的影响.
