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assessment of surfactant use in preterm infants as a marker of neonatal intensive care unit quality表面活性剂在早产儿中使用的评估质量新生儿重症监护病房的一个标志
Kaplan et al. BMC Health Services Research 2011, 11:22
/1472-6963/11/22
RESEARCH ARTICLE Open Access
Assessment of surfactant use in preterm infants as
a marker of neonatal intensive care unit quality
1,3,4* 2,3,4 4,5 4 2,4,6
Heather C Kaplan , Scott A Lorch , Jennifer Pinto-Martin , Mary Putt , Jeffrey H Silber
Abstract
Background: Proposed neonatal quality measures have included structural measures such as average daily census,
and outcome measures such as mortality and rates of complications of prematurity. However, process measures
have remained largely unexamined. The objective of this research was to examine variation in surfactant use as a
possible process measure of neonatal quality.
Methods: We obtained data on infants 30 to 34 weeks gestation admitted with respiratory distress syndrome
(RDS) within 48 hours of birth to 16 hospitals participating in the Pediatric Health Information Systems database
from 2001-2006. Models were developed to describe hospital variation in surfactant use and identify patient and
hospital predictors of use. Another cohort of all infants admitted within 24 hours of birth was used to obtain
adjusted neonatal intensive care unit (NICU) mortality rates. To assess the construct validity of surfactant use as a
quality metric, adjusted hospital rates of mortality and surfactant use were compared using Kendall’s tau.
Results: Of 3,633 infants, 46% received surfactant. For individual hospitals, the adjusted odds of surfactant use
varied from 2.2 times greater to 5.9 times less than the hospital with the median adjusted odds of surfactant use.
Increased annual admissions of extremely low birth weight infants to the NICU were associated with greater
surfactant use (OR 1
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