Brian C King1, Troy Richardson2, Ravi M Patel3, Henry C Lee4, Nicolas A Bamat5, Matthew Hall2, Jonathan L Slaughter6. 1. Department of Pediatrics, Section of Neonatology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA. bcking@bcm.edu. 2. Children's Hospital Association, Lenexa, KS, USA. 3. Division of Neonatology, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA, USA. 4. Division of Neonatology, Stanford University, Stanford, CA, USA. 5. Division of Neonatology, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA. 6. Division of Neonatology, Nationwide Children's Hospital, The Ohio State University, Columbus, OH, USA.
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.
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.