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Original article
Variation in hospital mortality in an Australian neonatal intensive care unit network
  1. Mohamed E Abdel-Latif1,2,
  2. Gen Nowak3,
  3. Barbara Bajuk4,
  4. Kathryn Glass5,
  5. David Harley5,6
  1. 1 Department of Neonatology, Centenary Hospital for Women and Children, Canberra Hospital, Garran, Australian Capital Territory, Australia
  2. 2 Discipline of Neonatology, Medical School, College of Medicine, Biology & Environment, Australian National University, Woden ACT, Australian Capital Territory, Australia
  3. 3 Research School of Finance, Actuarial Studies and Statistics, College of Business and Economics, Australian National University, Acton, Australian Capital Territory, Australia
  4. 4 NSW Pregnancy and Newborn Services Network, Sydney Children’s Hospitals Network, Randwick, New South Wales, Australia
  5. 5 Research School of Population Health and Medical School, Australian National University, Acton, Australian Capital Territory, Australia
  6. 6 Queensland Centre for Intellectual and Developmental Disability (QCIDD), Mater Research Institute, University of Queensland, South Brisbane, Queensland
  1. Correspondence to Professor Mohamed E Abdel-Latif, Department of Neonatology, The Australian National University, Medical School, Centenary Hospital for Women and Children, PO Box 11, Woden ACT, 2606, Australia; abdel-Latif.Mohamed{at}act.gov.au

Abstract

Background Studying centre-to-centre (CTC) variation in mortality rates is important because inferences about quality of care can be made permitting changes in practice to improve outcomes. However, comparisons between hospitals can be misleading unless there is adjustment for population characteristics and severity of illness.

Objective We sought to report the risk-adjusted CTC variation in mortality among preterm infants born <32 weeks and admitted to all eight tertiary neonatal intensive care units (NICUs) in the New South Wales and the Australian Capital Territory Neonatal Network (NICUS), Australia.

Methods We analysed routinely collected prospective data for births between 2007 and 2014. Adjusted mortality rates for each NICU were produced using a multiple logistic regression model. Output from this model was used to construct funnel plots.

Results A total of 7212 live born infants <32 weeks gestation were admitted consecutively to network NICUs during the study period. NICUs differed in their patient populations and severity of illness.

The overall unadjusted hospital mortality rate for the network was 7.9% (n=572 deaths). This varied from 5.3% in hospital E to 10.4% in hospital C. Adjusted mortality rates showed little CTC variation. No hospital reached the +99.8% control limit level on adjusted funnel plots.

Conclusion Characteristics of infants admitted to NICUs differ, and comparing unadjusted mortality rates should be avoided. Logistic regression-derived risk-adjusted mortality rates plotted on funnel plots provide a powerful visual graphical tool for presenting quality performance data. CTC variation is readily identified, permitting hospitals to appraise their practices and start timely intervention.

  • premature
  • mortality
  • variation
  • benchmarking

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/archdischild-2017-313222

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    Footnotes

    • Contributors MEA-L conceptualised and designed the study, carried out the statistical analyses, drafted the initial manuscript and led the writing. GN contributed to the statistical analysis and interpretation. BB retrieved and cleaned the data and contributed to statistical interpretation. KG contributed to the statistical interpretation. DH contributed to the study design and statistical interpretation and led the writing of manuscript. All authors critically reviewed and approved the final manuscript as submitted. All authors had full access to all of the data (including statistical reports and tables) in the study and can take responsibility for the integrity of the data and the accuracy of the data analysis.

    • Competing interests None declared.

    • Ethics approval The Australian National University (No 2015/029), ACT Health Human Research Ethics Committee (No ETH.11.09/1031) and Hunter New England Research Ethics and Governance Unit has approved this study.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement All authors had full access to all of the data (including statistical reports and tables) in the study and can take responsibility for the integrity of the data and the accuracy of the data analysis. No other data from the study are available.