Obstetrics
Association between level of delivery hospital and neonatal outcomes among South Carolina Medicaid recipients

https://doi.org/10.1067/mob.2000.107357Get rights and content

Abstract

Objective: The purpose of this study was to examine relationships between level of delivery hospital and neonatal mortality rate, length of stay, and Medicaid reimbursement. Study Design: This was a retrospective cohort study of 2560 infants with birth weights between 500 and 1499 g who were born between 1991 and 1995 to South Carolina mothers and whose care was covered by Medicaid. Results: The relative risk of neonatal death for infants born in level I and II hospitals (relative risk, 1.9; 95% confidence interval, 1.6-2.2) but not level II hospitals with 24-hour neonatology coverage (relative risk, 1.2; 95% confidence interval, 0.7-1.9) was higher than that for infants born in level III hospitals. Compared with infants born in level III hospitals mean length of stay was longer and Medicaid reimbursement was similar for infants born in level I and II hospitals. Among infants born in level II hospitals with 24-hour neonatology coverage length of stay was shorter and Medicaid reimbursement was lower. Conclusion: Infants born in level I and II hospitals had higher neonatal mortality rates and longer stays than did infants born in level III hospitals, despite similar Medicaid reimbursement. (Am J Obstet Gynecol 2000;183:1504-11.)

Section snippets

Material and methods

After approval was obtained from the University of South Carolina’s institutional review board, we performed a retrospective cohort analysis to examine these relationships. The cohort consisted of infants with birth weights between 500 and 1499 g who were born between 1991 and 1995 to mothers who were South Carolina residents and received Medicaid for neonatal care of the infant. The exposure variable, level of hospital, was first categorized as level I, level II without 24-hour neonatology

Results

Table II presents the demographic characteristics of mothers and infants included in the neonatal mortality analysis according to level of delivery hospital.

. Characteristics of mothers and VLBW infants according to level of delivery hospital

CharacteristicLevel I (n = 109)Level II (n = 325)Enhanced level II (n = 88)Level III (n = 2038)
No.%No.%No.%No.%
Maternal transfer*
 No109100.032399.488100.0153675.4
 Yes00.020.600.050224.6
Infant transfer*
 No2825.711736.05056.8153375.2
 Yes8174.320864.03843.250524.8

Comment

In agreement with several recent studies we found higher neonatal mortality rates among VLBW infants born outside level III hospitals than among infants born in level III hospitals.6, 7, 8, 9, 10 A recent study of 62 neonatal intensive care units participating in the Vermont Oxford Network reported no difference in standardized neonatal mortality ratios according to annual neonatal intensive care unit volume.20 Those investigators may not have found an association between neonatal intensive

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    Reprint requests: Maureen Sanderson, PhD, Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC 29208.

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