Scores that evaluate newborn intensive care units are inconsistent

Mon Mar 4, 2013 11:16am EST

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Future tools should build on success of current scores to improve care for
vulnerable infants, according to U-M research published in Pediatrics  

ANN ARBOR, Mich.,  March 4, 2013  /PRNewswire-USNewswire/ -- Scoring methods
commonly used to evaluate Newborn Intensive Care Units (NICU) are inconsistent,
according to new research from the  University of Michigan.

The research published last week in the journal  Pediatrics  compared 10
well-known scores that have been developed to evaluate NICUs. The researchers
found more differences than similarities.

"This raises the question: do these scores level the playing field well enough,
or are scores still somewhat unfair?  And what more can we learn about the major
causes of mortality for infants in neonatal intensive care?  By doing research
to improve tools to adjust hospital scores, we believe that it will be possible
to improve care for these very vulnerable infants," says  Stephen W. Patrick,
M.D., M.P.H., M.S., lead author of the study and a fellow in the  University of
Michigan's division of neonatal and perinatal medicine at C.S. Mott Children's
Hospital.

Parents and payers want to be able to know which hospitals do the best job
taking care of newborns - especially newborns with life-threatening illness,
Patrick says.  Currently, much effort is put forth to help the public understand
the quality of care that hospitals are providing, using scores like these
applied to NICUs.

Patrick and his U-M co-authors  Matthew M. Davis, M.D., M.A.P.P., associate
professor in the Child Health Evaluation and Research Unit and  Robert
Schumacher, M.D., professor of neonatal-perinatal medicine, looked at 10
different neonatal mortality risk adjustment scores, including the Clinical Risk
Index for Babies and the National Institutes of Child Health and Human
Development "calculator." The scores differed substantively in intended purpose,
in areas like research, clinical management or performance.

The scores are also inconsistent in timing of data collection and inclusion of
co-morbidity indicators.

"Giving scores to hospitals is trickier than it may seem - largely because some
hospitals take care of especially high numbers of very sick babies, and their
scores can look worse than hospitals taking care of healthier babies.  In other
words, hospitals with sicker infants are taking a harder 'test,' says Patrick.

The researchers stress that an evaluation or scoring process is essential, but
more meaningful comparisons are needed.

"To make fairer comparisons, researchers have developed different 'risk
adjustment' techniques over the last 20 years.  But our research shows that
these adjusted scores may not always level the playing field when comparing one
hospital to another. Moreover, some of these tools are being used in ways they
were not originally intended. We hope additional research in this area can both
improve the care for patients and allow for reliable comparisons of
institutions," says Schumacher.  

Journal citation:  doi:10.1542/peds.2012-1427h

Funding: This work was supported by a grant from the Robert Wood Johnson
Foundation Clinical Scholars Program.  

About C.S. Mott Children's Hospital in the  University of Michigan  Health
System:

Since 1903, the  University of Michigan  has led the way in providing
comprehensive, specialized health care for children. From leading-edge heart
surgery that's performed in the womb to complete emergency care that's there
when you need it, families from all over come to the  University of Michigan 
C.S. Mott Children's Hospital for our pediatric expertise. In 2013, C.S. Mott
Children's Hospital was ranked eighth in the nation in Parents Magazine's 10
Best Children's Hospitals ranking.

C.S. Mott Children's Hospital's Division of Neonatal-Perinatal Medicine is a
specialized, nationally-recognized group of neonatologists who provide care to
newborn infants at the Brandon Newborn Intensive Care Unit (NICU). As a level IV
NICU, providing the highest level of newborn intensive care, approximately 25
percent of our patients are transported to the U-M Health System Newborn ICU
from other NICU's for advanced therapies, such as extracorporeal membrane
oxygenation (ECMO), high-frequency ventilation and therapeutic hypothermia after
birth asphyxia, or for coordination of complex care with our full range of
medical and surgical specialty services.

SOURCE   University of Michigan  C.S. Mott Children's Hospital


Mary F. Masson, mfmasson@umich.edu, +1-734-764-2220

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