Prioritization framework for improving the value of care for very low birth weight and very preterm infants

• Authors: Brian C. King, Baylor College of Medicine; Troy Richardson, Children’s Hospital Association; Ravi Patel, Emory University; Henry C. Lee, Stanford University; Nicolas A. Bamat, University of Pennsylvania; Matthew Hall, Children’s Hospital Association; Jonathan L. Slaughter, Ohio State University
• Journal Title: Journal of Perinatology
• Volume: Volume 41, Number 10
• Publisher: Springer Nature [academic journals on nature.com] | 2021-06-01, Pages 2463-2473
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.1038/s41372-021-01114-6
• Subjects: Health Sciences, Medicine and Surgery; Health Sciences, Obstetrics and Gynecology
• Keywords: Health care economics; Paediatrics; Health services

Abstract

Objective Create a prioritization framework for value-based improvement in neonatal care. Study design A retrospective cohort study of very low birth weight (<1500 g) and/or very preterm (<32 weeks) infants discharged between 2012 and 2019 using the Pediatric Health Information System Database. Resource use was compared across hospitals and adjusted for patient-level differences. A prioritization score was created combining cost, patient exposure, and inter-hospital variability to rank resource categories. Results Resource categories with the greatest cost, patient exposure, and inter-hospital variability were parenteral nutrition, hematology (lab testing), and anticoagulation (for central venous access and therapy), respectively. Based on our prioritization score, parenteral nutrition was identified as the highest priority overall. Conclusions We report the development of a prioritization score for potential value-based improvement in neonatal care. Our findings suggest that parenteral nutrition, central venous access, and high-volume laboratory and imaging modalities should be priorities for future comparative effectiveness and quality improvement efforts.