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Moderately premature infants at Kaiser Permanente Medical Care Program in California are discharged home earlier than their peers in Massachusetts and the United Kingdom
  1. J Profit1,2,3,
  2. J A F Zupancic1,
  3. M C McCormick1,4,
  4. D K Richardson1,
  5. G J Escobar5,
  6. J Tucker6,
  7. W Tarnow-Mordi6,7,
  8. G Parry8
  1. 1Harvard Newborn Medicine Program, Children’s Hospital Boston and Beth Israel Deaconess Medical Center, Boston, MA 02115, USA
  2. 2Baylor College of Medicine, Texas Children’s Hospital, Department of Pediatrics, Section of Neonatology, Houston, TX 77030, USA
  3. 3Houston Center for Quality of Care and Utilization Studies, Department of Veterans Affairs, Health Services Research and Development Center of Excellence, Houston Veterans Affairs Medical Center, Houston, TX 77030, USA
  4. 4Department of Society, Human Development and Health, Harvard School of Public Health, Boston, MA 02115, USA
  5. 5Perinatal Research Unit, Kaiser Permanente Medical Care Program, Oakland, CA 94612, USA
  6. 6Dugald Baird Centre for Research on Women’s Health, Department of Obstetrics and Gynaecology, University of Aberdeen, Aberdeen AB25 2ZL, Scotland, UK
  7. 7Westmead and Children’s Hospital at Westmead, University of Sydney at Westmead Hospital, Wentworthville, NSW, Australia
  8. 8Health Services Research, School of Health and Related Research, University of Sheffield, Sheffield, UK
  1. Correspondence to:
    Dr Profit
    Houston Center for Quality of Care & Utilization Studies, Division of Health Policy and Quality, VA HSR&D (152), 2002 Holcombe Boulevard, Houston, TX 77030, USA; profit{at}


Objective: To compare gestational age at discharge between infants born at 30–34+6 weeks gestational age who were admitted to neonatal intensive care units (NICUs) in California, Massachusetts, and the United Kingdom.

Design: Prospective observational cohort study.

Setting: Fifty four United Kingdom, five California, and five Massachusetts NICUs.

Subjects: A total of 4359 infants who survived to discharge home after admission to an NICU.

Main outcome measures: Gestational age at discharge home.

Results: The mean (SD) postmenstrual age at discharge of the infants in California, Massachusetts, and the United Kingdom were 35.9 (1.3), 36.3 (1.3), and 36.3 (1.9) weeks respectively (p  =  0.001). Compared with the United Kingdom, adjusted discharge of infants occurred 3.9 (95% confidence interval (CI) 1.4 to 6.5) days earlier in California, and 0.9 (95% CI −1.2 to 3.0) days earlier in Massachusetts.

Conclusions: Infants of 30–34+6 weeks gestation at birth admitted and cared for in hospitals in California have a shorter length of stay than those in the United Kingdom. Certain characteristics of the integrated healthcare approach pursued by the health maintenance organisation of the NICUs in California may foster earlier discharge. The California system may provide opportunities for identifying practices for reducing the length of stay of moderately premature infants.

  • IMD, index of multiple deprivation
  • KPMCP, Kaiser Permanente medical care program
  • MPIP, moderately premature infant project
  • NICU, neonatal intensive care unit
  • PMAD, postmenstrual age at discharge
  • UKNSS, United Kingdom neonatal staffing study
  • healthcare economics and organisation
  • premature
  • hospital stay
  • discharge
  • risk adjustment

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  • Published Online First 31 January 2006

  • Funding: The Agency for Healthcare Research and Quality supported JP with a training grant (T32 HS000063). The MPIP study was funded by a grant from the same organisation (R01 HS10131). The Commonwealth Fund, a national, private foundation based in New York City that supports independent research on health and social issues, supported GP in writing this paper. The views presented here are those of the authors and not necessarily those of The Commonwealth Fund, its director, officers, or staff. GJP is a member of the UKNSS group, which was funded by the NHS R&D Executive, Mother and Child Health Programme (MCH: 6–7).

  • Competing interests: none declared

  • Dr Richardson is deceased