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American Academy of Pediatrics
Research Articles

Small-Area Variation in the Care of Low-Risk Neonates in Massachusetts and Texas

Samantha A. House, Neetu Singh, Jared R. Wasserman, Youngran Kim, Cecilia Ganduglia-Cazaban and David C. Goodman
Hospital Pediatrics December 2020, 10 (12) 1059-1067; DOI: https://doi.org/10.1542/hpeds.2020-000687
Samantha A. House
aDepartment of Pediatrics, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire;
bDepartment of Pediatrics, Children’s Hospital at Dartmouth-Hitchcock, Lebanon, New Hampshire;
cThe Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire; and
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Neetu Singh
aDepartment of Pediatrics, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire;
bDepartment of Pediatrics, Children’s Hospital at Dartmouth-Hitchcock, Lebanon, New Hampshire;
cThe Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire; and
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Jared R. Wasserman
cThe Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire; and
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Youngran Kim
dDivision of Management, Policy and Community Health, School of Public Health, The University of Texas Health Science Center at Houston, Houston, Texas
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Cecilia Ganduglia-Cazaban
dDivision of Management, Policy and Community Health, School of Public Health, The University of Texas Health Science Center at Houston, Houston, Texas
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David C. Goodman
aDepartment of Pediatrics, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire;
cThe Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire; and
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Abstract

BACKGROUND: The success of neonatal intensive care in improving outcomes for critically ill neonates led to rapid growth of NICU use in the United States, despite a relatively stable birth cohort. Less is known about NICU use among late-preterm and term infants, although recent studies have observed wide variation in their care patterns. In this study, we measure special care days (SCDs) (intermediate or intensive), length of stay, and readmission rates among low-risk neonates across regions within 2 states.

METHODS: In this retrospective cohort study, we analyzed data from Massachusetts (all payer claims) and Texas (BlueCross BlueShield) from 2009 to 2012. A low-risk cohort was defined by identifying newborns with diagnostic codes indicating a gestational age ≥35 weeks and birth weight ≥1500 g and excluding infants with diagnoses and procedures generally necessitating nonroutine care. Outcomes were measured across neonatal intensive care regions by diagnosis and payer type.

RESULTS: We identified 255 311 low-risk newborns. SCD use varied nearly sixfold across neonatal intensive care regions. Use was highest among commercially insured Texas infants (8.42 per 100), followed by Medicaid-insured Massachusetts infants (6.67 per 100) and commercially insured Massachusetts infants (5.15 per 100). Coefficients of variation indicated high variation within each payer-specific cohort and moderate to high variation across each condition. No consistent relationship between regional SCD use and 30-day readmissions was identified.

CONCLUSIONS: Use of NICU services varied widely across regions in this cohort of low-risk infants. Further investigation is needed to delineate outcomes associated with patterns of care received by this population.

  • Copyright © 2020 by the American Academy of Pediatrics
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Hospital Pediatrics: 10 (12)
Hospital Pediatrics
Vol. 10, Issue 12
1 Dec 2020
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Small-Area Variation in the Care of Low-Risk Neonates in Massachusetts and Texas
Samantha A. House, Neetu Singh, Jared R. Wasserman, Youngran Kim, Cecilia Ganduglia-Cazaban, David C. Goodman
Hospital Pediatrics Dec 2020, 10 (12) 1059-1067; DOI: 10.1542/hpeds.2020-000687

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Small-Area Variation in the Care of Low-Risk Neonates in Massachusetts and Texas
Samantha A. House, Neetu Singh, Jared R. Wasserman, Youngran Kim, Cecilia Ganduglia-Cazaban, David C. Goodman
Hospital Pediatrics Dec 2020, 10 (12) 1059-1067; DOI: 10.1542/hpeds.2020-000687
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