Funded Projects

Competition Volume, NICU Level & Outcomes in California

Grantee: Northwestern University
Principal Investigator: Min-Woong Sohn
Project Number: R40MC07678
Project Date: 09/01/2006

Final Report

Competition Volume, NICU Level & Outcomes in California Final Report (PDF)

Age group(s)

• Perinatal/Infancy (0-12 months)
• Middle Childhood (6-11 years)

Abstract

The objective of this study is to examine the effect of both competition and volume on outcomes for infants treated in California between 1993 and 2002. Volume has been widely known to effect mortality in many specialized clinical areas such as cardiac artery bypass grafting, coronary angioplasty, and various cancer surgeries. Previous research also showed that both the level of neonatal intensive care unit (NICU) and volume were negatively associated with mortality of low-birthweight infants. In our study, we will extend the volume-outcome research in neonatal intensive care by examining the effect of competition on the mortality of infants. In addition to the effect of volume, level of care, and other organizational and environmental characteristics. The data will be obtained from the California Office of Statewide Health Planning and Development, where a special project is under way to link patient discharge abstracts with the Birth Cohort File (Linked Data). We will use the admission and death dates of infants to construct our dependent variables: in-hospital mortality, neonatal morality (deaths within 28 days of birth) and readmission rates within 30 days after discharge. The Linked Data will also allow us to use various maternal and infant risk factors in our analyses for risk adjustment. Based on previous research in volume-outcome relationships, policy makers and purchasers are pushing for selective referral (or what the Leapfrog group calls "evidence-based hospital referral") to high-volume hospitals as a strategy for increasing quality of care. However, our preliminary research in NICU cares shows that (1) increased volume does not decrease mortality for hospitals under intense competition and (2) competition is associated with increased mortality for hospitals with high volume. This suggests that selective referral to high-volume hospitals may not achieve its intended effect of increasing quality unless competition is taken into account. This study will allow us to test the "managed competition" hypothesis that competition can both reduce cost and increase quality against the alternative "cost-quality tradeoff" hypothesis that hospitals will skimp on quality under reduced cost. This study is also relevant to the MCH's research issues in its focus on both health care delivery systems and quality of care in neonatal intensive care. Its findings have potential for improving the social organization of neonatal intensive care units, which in turn can potentially save many lives of high-risk infants.