Variation in hospital mortality in an Australian neonatal intensive care unit network

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dc.contributor.authorMohamed, Abdel-Latif
dc.contributor.authorNowak, Gen
dc.contributor.authorBajuk, Barbara
dc.contributor.authorGlass, Kathryn
dc.contributor.authorHarley, David
dc.date.accessioned2019-11-26T00:45:07Z
dc.date.available2019-11-26T00:45:07Z
dc.date.issued2017
dc.date.updated2019-05-19T08:23:42Z
dc.description.abstractBackground: Studying centre-to-centre (CTC) variation in mortality rates is important because inferences about quality of care can be made permitting changes in practice to improve outcomes. However, comparisons between hospitals can be misleading unless there is adjustment for population characteristics and severity of illness. Objective: We sought to report the risk-adjusted CTC variation in mortality among preterm infants born <32 weeks and admitted to all eight tertiary neonatal intensive care units (NICUs) in the New South Wales and the Australian Capital Territory Neonatal Network (NICUS), Australia. Methods: We analysed routinely collected prospective data for births between 2007 and 2014. Adjusted mortality rates for each NICU were produced using a multiple logistic regression model. Output from this model was used to construct funnel plots. Results: A total of 7212 live born infants <32 weeks gestation were admitted consecutively to network NICUs during the study period. NICUs differed in their patient populations and severity of illness. The overall unadjusted hospital mortality rate for the network was 7.9% (n=572 deaths). This varied from 5.3% in hospital E to 10.4% in hospital C. Adjusted mortality rates showed little CTC variation. No hospital reached the +99.8% control limit level on adjusted funnel plots. Conclusion: Characteristics of infants admitted to NICUs differ, and comparing unadjusted mortality rates should be avoided. Logistic regression-derived risk-adjusted mortality rates plotted on funnel plots provide a powerful visual graphical tool for presenting quality performance data. CTC variation is readily identified, permitting hospitals to appraise their practices and start timely intervention.
dc.format.mimetypeapplication/pdfen_AU
dc.identifier.issn1359-2998en_AU
dc.identifier.urihttp://hdl.handle.net/1885/186644
dc.language.isoen_AUen_AU
dc.provenanceThis is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/ licenses/by-nc/4.0/ © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.en_AU
dc.publisherBMJ Publishing Groupen_AU
dc.rights© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018.en_AU
dc.rights.licenseCreative Commons Attribution Non Commercial (CC BY-NC 4.0) licenseen_AU
dc.rights.urihttp://creativecommons.org/ licenses/by-nc/4.0/en_AU
dc.sourceArchives of Disease in Childhood Fetal and Neonatal Editionen_AU
dc.titleVariation in hospital mortality in an Australian neonatal intensive care unit networken_AU
dc.typeJournal articleen_AU
dcterms.accessRightsOpen Accessen_AU
local.bibliographicCitation.issue4en_AU
local.bibliographicCitation.lastpageF336en_AU
local.bibliographicCitation.startpageF331en_AU
local.contributor.affiliationMohamed, Abdel-Latif, College of Health and Medicine, ANUen_AU
local.contributor.affiliationNowak, Gen, College of Business and Economics, ANUen_AU
local.contributor.affiliationBajuk, Barbara, NSW Pregnancy and Newborn Services Networken_AU
local.contributor.affiliationGlass, Kathryn, College of Health and Medicine, ANUen_AU
local.contributor.affiliationHarley, David, College of Health and Medicine, ANUen_AU
local.contributor.authoremailu4053649@anu.edu.auen_AU
local.contributor.authoruidMohamed, Abdel-Latif, u4908240en_AU
local.contributor.authoruidNowak, Gen, u3237839en_AU
local.contributor.authoruidGlass, Kathryn, u4053649en_AU
local.contributor.authoruidHarley, David, u3881428en_AU
local.description.notesImported from ARIES
local.identifier.absfor111403 - Paediatricsen_AU
local.identifier.absseo920501 - Child Healthen_AU
local.identifier.ariespublicationu5369653xPUB183en_AU
local.identifier.citationvolume103en_AU
local.identifier.doi10.1136/archdischild-2017-313222en_AU
local.identifier.scopusID2-s2.0-85049028283
local.identifier.uidSubmittedByu5369653en_AU
local.publisher.urlhttps://www.biomedcentral.com/en_AU
local.type.statusPublished Versionen_AU

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