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Hospital variation in extremely preterm birth

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Abstract

Objective

Given that regionalization of extremely preterm births (EPTBs) is associated with improved infant outcomes, we assessed between-hospital variation in EPTB stratified by hospital level of neonatal care, and determined the proportion of variance explained by differences in maternal and hospital factors.

Study design

We assessed 7,046,253 births in California from 1997 to 2011, using hospital discharge, birth, and death certificate data. We estimated the association between maternal and hospital factors and EPTB using multivariable regression, calculated hospital-specific EPTB frequencies, and estimated between-hospital variances and median odds ratios, stratified by hospital level of care.

Result

Hospital frequencies of EPTB ranged from 0% to 2.5%. Between-hospital EPTB frequencies varied substantially, despite stratifying by hospital level of care and accounting for confounding factors.

Conclusion

Our results demonstrate differences in EPTBs among hospitals with level 1 and 2 neonatal care, an area to target for future research and quality improvement.

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Fig. 1: Extremely preterm birth (EPTB) frequencies by hospital rank and birth volume.
Fig. 2

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Data availability

The datasets used in this study are publicly available from the California Office of Statewide Planning and Development. The coding and raw data generated during our analyses are available from the corresponding author upon reasonable request.

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Acknowledgements

This work was supported by the March of Dimes Prematurity Research Center at Stanford University and by the Stanford Maternal and Child Health Research Institute. Research reported in this publication was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development of the National Institutes of Health under award number R01HD098287. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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Author notes

  1. These authors contributed equally: Gary M. Shaw, Henry C. Lee.

Authors and Affiliations

  1. Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA

    Gregory P. Goldstein, Peiyi Kan, Ciaran S. Phibbs, Gary M. Shaw & Henry C. Lee

  2. Health Economics Resource Center and Center for Implementation to Innovation, Veterans Affairs Palo Alto Healthcare System, Menlo Park, CA, USA

    Ciaran S. Phibbs

  3. Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA, USA

    Elliott Main

  4. California Maternal Quality Care Collaborative, Stanford, CA, USA

    Elliott Main

  5. California Perinatal Quality Care Collaborative, Stanford, CA, USA

    Henry C. Lee

Authors
  1. Gregory P. Goldstein
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  4. Elliott Main
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Contributions

GPG, PK, CSP, EM, GMS, and HCL planned and designed the study. PK and HCL acquired the data. PK and GPG analyzed the data. GPG wrote the initial manuscript draft. All authors edited the manuscript. GPG had the primary responsibility for the final content. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Gregory P. Goldstein.

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The authors declare no competing interests.

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Goldstein, G.P., Kan, P., Phibbs, C.S. et al. Hospital variation in extremely preterm birth. J Perinatol 42, 1686–1694 (2022). https://doi.org/10.1038/s41372-022-01505-3

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