Office of Epidemiology and Research, Division of Research

Advancing Applied MCH Research

Aggregated Complication Measure for Neonatal Quality of Care

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Project Number: R40 MC 05474-03
Grantee: Children's Hospital of Philadelphia
Department/Center: Joseph Stokes, Jr. Research Institute
Project Date: 09/01/2005

Final Report

Aggregated Complication Measure for Neonatal Quality of Care Final Report (PDF) Exit Disclaimer

Principal Investigator

Scott Andrew Lorch, M.D., MSCE
Assistant Professor
3615 Civic Center Boulevard
Philadelphia, PA  19104-4318
Phone: (215) 590-1714


  • Perinatal/Infancy (0-12 months)


Every year in the United States over 57,000 infants are delivered at least two months prematurely. Many of these infants are severely disabled, and their estimated cost for medical care to age 18 is between 4 and 5.4 billion dollars. A large part of these long-term costs result from complications developed after birth in the neonatal intensive care unit (NICU). While some outcomes are an unavoidable consequence of premature birth, increased cost and long-term disabilities may result from the quality of care these infants received in the NICU. However, there are no validated measures of the quality of neonatal care; currently available measures, such as mortality and individual complication rates, lack adequate power and validity and are confounded by influences outside the control o f the NICU. This study will develop and validate a new quality measure, the aggregate complication measure (ACM), to evaluate hospitals according to the quality of care they provide after using direct standardization methods to control for differences in casemix. This study will use population data from Pennsylvania, New York, and California, with an estimated 95,000 premature births each year. Statistical modeling techniques will determine valid weights for each complication based on the impact of each complication on one of four outcomes of interest: death, length of stay, cost, or 28-day readmissions. This project fulfills MCH Strategic Research Issues III, "Systems to assure quality of care for MCH populations" by giving policy makers a validated method of assessing and assuring the quality of neonatal care at individual hospitals. Additionally, this project fulfills MCH Strategic Research Issue I, "Public health service systems and infrastructures at the community, state, and/or national levels, as they apply to different maternal and child health populations based on demographic, epidemiological, and/or other factors" by determining the optimal location of care for different populations of high-risk infants. Completion of this project will produce a valid measure of neonatal quality to both evaluate hospitals and quantify the difference in quality between hospitals. Improved measures of neonatal quality will help facilitate initiatives to lower costs and improve the quality of neonatal care by reducing unnecessary morbidity and mortality in these infants.


Listed is descending order by year published.

Hsu JY, Lorch SD, Small DS. Perils and prospects of using aggregate area level socioeconomic information s a proxy for individual level socioeconomic confounders in instrumental variables regression. Health Serv Outcomes Res Method. 2012;12(2/3):119-140.

Lorch SA, Kroelinger CD, Ahlberg C, Barfield WD. Factors that mediate racial/ethnic disparities in US fetal death rates. Am J Public Health. 2012 Oct;102(10):1902-10. doi: 10.2105/AJPH.2012.300852. Epub 2012 Aug 16. PubMed PMID: 22897542.

Ray KN, Lorch SA. Hospitalization of rural and urban infants during the first year of life. Pediatrics. 2012 Dec;130(6):1084-93. doi: 10.1542/peds.2012-0020. Epub 2012 Nov 5. PubMed PMID: 23129078.

Goyal NK, Fager C, Lorch SA. Adherence to discharge guidelines for late-preterm newborns. Pediatrics. 2011 Jul;128(1):62-71. doi: 10.1542/peds.2011-0258. Epub 2011 Jun 20. PubMed PMID: 21690121.

Tucker Edmonds B, Fager C, Srinivas S, Lorch S. Predictors of cesarean delivery for periviable neonates. Obstet Gynecol. 2011 Jul;118(1):49-56. doi: 10.1097/AOG.0b013e31821c4071. Erratum in: Obstet Gynecol. 2011 Oct;118(4):961-2. PubMed PMID: 21691162.

Tucker Edmonds B, Fager C, Srinivas S, Lorch S. Racial and ethnic differences in use of intubation for periviable neonates. Pediatrics. 2011 May;127(5):e1120-7. doi: 10.1542/peds.2010-2608. Epub 2011 Apr 18. PubMed PMID: 21502221.

Srinivas SK, Fager C, Lorch SA. Evaluating risk-adjusted cesarean delivery rate as a measure of obstetric quality. Obstet Gynecol. 2010 May;115(5):1007-13. doi: 10.1097/AOG.0b013e3181d9f4b6. PubMed PMID: 20410776.

Lorch SA, Wade KC, Bakewell-Sachs S, Medoff-Cooper B, Escobar GJ, Silber JH. Racial differences in the use of respiratory medications in premature infants after discharge from the neonatal intensive care unit. J Pediatr. 2007 Dec;151(6):604-10, 610.e1. Epub 2007 Aug 24.


Preterm, Health Care Quality, Health Care Costs, Mortality

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