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Gabriel J. Escobar - One of the best experts on this subject based on the ideXlab platform.
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phototherapy use in jaundiced newborns in a large Managed Care Organization do clinicians adhere to the guideline
Pediatrics, 2003Co-Authors: Lee R Atkinson, Gabriel J. Escobar, John I Takayama, Thomas B NewmanAbstract:Objective. In 1994, the American Academy of Pediatrics (AAP) published a practice guideline with age-specific thresholds for phototherapy for healthy term newborns with hyperbilirubinemia. The purpose of this study was to examine adherence to the guideline in a large Managed Care Organization. Methods. We conducted a retrospective cross-sectional analysis of linked computerized databases from 11 Northern California Kaiser Permanente Medical Care Program hospitals. Newborn infants included were at least 37 weeks of gestation, had birth weights of at least 2500 g, and were born between January 1, 1995, and December 31, 1996. The primary outcome variable for the study was receipt of phototherapy according to the guideline. Total serum bilirubin (TSB) and infant age in hours at the time of bilirubin measurement were used to classify infants into 3 groups according to the AAP guideline: recommend phototherapy (R), consider phototherapy (C), and did not recommend phototherapy (N). Group R included infants with TSB levels of at least 15 mg/dL before 48 hours of age, at least 18 mg/dL before 72 hours, or at least 20 mg/dL after 72 hours. Group C included infants not in group R, with TSB levels of at least 12 mg/dL before 48 hours, 15 mg/dL before 72 hours, or at least 17 mg/dL after 72 hours. Group N included infants who were in neither group R nor group C and also did not have significant jaundice before 24 hours of age. Phototherapy codes from electronic databases were validated by chart review for a subset of 550 infants. Results. Compared with chart review, phototherapy codes in the database were 94.4% sensitive (95% confidence interval [CI]: 89.1%–97.5%) and 100% specific (95% CI: 99.25%–100%). Among the 47 801 infants eligible, 2.3% received phototherapy. Phototherapy was administered to 54% of 1194 infants in group R (range across hospitals: 27%–77%), 16% of 2245 infants in group C (range: 5%–37%), and 0.2% of 44 362 infants in group N (range: 0.1%–0.6%). The predictors of phototherapy for group R, the group for whom phototherapy was recommended, determined by logistic regression were increasing TSB levels (odds ratio [OR]: 1.6/mg/dL; 95% CI: 1.4–1.7), reaching the AAP threshold at 24 to 47.9 hours of age compared with 48 hours or more (OR: 7.1; 95% CI: 4.3–11.9), gestational age of 37 weeks compared with 38 weeks or more (OR: 1.6; 95% CI: 1.1–2.3), age when phototherapy was first recommended (OR: 0.7/d; 95% CI: 0.6–0.8), and facility of birth (OR: 0.2–2.7). The facility of birth was a strong predictor of phototherapy use in all groups (R, C, and N). Conclusions. Clinicians provided phototherapy to only 54% of term infants with hyperbilirubinemia for whom it was recommended by the AAP. There is marked interhospital variation in phototherapy use in this large Managed Care system. Improved adherence to the guideline would require only a slight increase in the total rate of phototherapy use if unnecessary use for infants with lower levels of TSB were simultaneously decreased.
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jaundice noted in the first 24 hours after birth in a Managed Care Organization
JAMA Pediatrics, 2002Co-Authors: Thomas B Newman, Petra Liljestrand, Gabriel J. EscobarAbstract:Objective To investigate the significance of jaundice noted in the first 24 hours after birth in a community setting. Design Supplementary analyses of a nested case-control study. Setting Northern California Kaiser Permanente Medical Care Program. Patients Six hundred thirty-one randomly selected newborns (controls) and 140 cases with total serum bilirubin levels of 25 mg/dL (428 µmol/L) or higher from a cohort of 105 384 newborns of at least 2000 g birth weight and at least 36 weeks' gestational age, born between January 1, 1995, and December 31, 1998. Main Outcome Measures Notations of jaundice in the medical record, timing and results of bilirubin testing, use of phototherapy, and development of bilirubin levels of 25 mg/dL or higher. Results Among the controls, the cumulative probability of a notation of jaundice (corrected for early hospital discharge using survival analysis) was 2.8% within 18 hours and 6.7% within 24 hours. In these newborns, cumulative proportions that had bilirubin levels measured were 38% within 12 hours and 43% within 24 hours of when jaundice was first noted. About 40% of bilirubin levels measured within 24 hours were above the estimated 95th percentile for age. Compared with newborns not noted to be jaundiced on the first day, newborns noted to be jaundiced within 24 hours were more likely to receive phototherapy (18.9% vs 1.7%; relative risk, 10.1; 95% confidence interval, 4.2-24.4) and to develop a bilirubin level of 25 mg/dL or higher (odds ratio, 2.9; 95% confidence interval, 1.6-5.2), but the absolute risk increase for total serum bilirubin levels of 25 mg/dL or higher was 0.2%. Conclusion Jaundice noted in the medical record in the first 24 hours after birth was uncommon and often clinically significant in this setting, but other factors also need to be considered in determining its importance.
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Neonatal Assisted Ventilation: Predictors, Frequency, and Duration in a Mature Managed Care Organization
Pediatrics, 2000Co-Authors: Alexandra Wilson, Mary Anne Armstrong, Marla N. Gardner, Bruce F. Folck, Gabriel J. EscobarAbstract:Objectives. Reference data are lacking on the frequency and duration of assisted ventilation in neonates. This information is essential for determining resource needs and planning clinical trials. As mortality becomes uncommon, ventilator utilization is increasingly used as a measure for assessing therapeutic effect and quality of Care in intensive Care medicine. Valid comparisons require adjustments for differences in a patient9s baseline risk for assisted ventilation and prolonged ventilator support. The aims of this study were to determine the frequency and length of ventilation (LOV) in preterm and term infants and to develop models for predicting the need for assisted ventilation and length of ventilator support. Methods. We performed a retrospective, population-based cohort study of 77 576 inborn live births at 6 Northern California hospitals with level 3 intensive Care nurseries in a group-model Managed Care Organization. The gestational age-specific frequency and duration of assisted ventilation among surviving infants was determined. Multivariable regression was performed to determine predictors for assisted ventilation and LOV. Results. Of 77 576 inborn live births in the study, 11 199 required admission to the neonatal intensive Care unit and of these, 1928 survivors required ventilator support. The proportion of infants requiring assisted ventilation and the median LOV decreased markedly with increasing gestational age. In addition to gestational age, admission illness severity, 5-minute Apgar scores, presence of anomalies, male sex, and white race were important predictors for the need for assisted ventilation. The ability of the models to predict need for ventilation was high, and significantly better than birth weight alone with an area under the receiver operating characteristic curve of .90 versus .70 for preterm infants, and .88 versus .50 for term infants. For preterm infants, gestational age, admission illness severity, oxygenation index, anomalies, and small-for-gestational age status were significant predictors for LOV, accounting for 60% of the variance in the length of assisted ventilation. For term infants, oxygenation index and anomalies were significant predictors but only accounted for 29% of the variance. Conclusions. Considerable variation exists in the utilization of ventilator support among infants of closely related gestational age. In addition, a number of medical risk factors influence the need for, and length of, assisted ventilation. These models explain much of the variance in LOV among preterm infants but explain substantially less among term infants. neonatal intensive Care, assisted ventilation, Score for Neonatal Acute Physiology, resource consumption, prematurity.
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Neonatal assisted ventilation: predictors, frequency, and duration in a mature Managed Care Organization.
Pediatrics, 2000Co-Authors: Alexandra Wilson, Mary Anne Armstrong, Marla N. Gardner, Bruce F. Folck, Gabriel J. EscobarAbstract:Reference data are lacking on the frequency and duration of assisted ventilation in neonates. This information is essential for determining resource needs and planning clinical trials. As mortality becomes uncommon, ventilator utilization is increasingly used as a measure for assessing therapeutic effect and quality of Care in intensive Care medicine. Valid comparisons require adjustments for differences in a patient's baseline risk for assisted ventilation and prolonged ventilator support. The aims of this study were to determine the frequency and length of ventilation (LOV) in preterm and term infants and to develop models for predicting the need for assisted ventilation and length of ventilator support. We performed a retrospective, population-based cohort study of 77 576 inborn live births at 6 Northern California hospitals with level 3 intensive Care nurseries in a group-model Managed Care Organization. The gestational age-specific frequency and duration of assisted ventilation among surviving infants was determined. Multivariable regression was performed to determine predictors for assisted ventilation and LOV. Of 77 576 inborn live births in the study, 11 199 required admission to the neonatal intensive Care unit and of these, 1928 survivors required ventilator support. The proportion of infants requiring assisted ventilation and the median LOV decreased markedly with increasing gestational age. In addition to gestational age, admission illness severity, 5-minute Apgar scores, presence of anomalies, male sex, and white race were important predictors for the need for assisted ventilation. The ability of the models to predict need for ventilation was high, and significantly better than birth weight alone with an area under the receiver operating characteristic curve of.90 versus.70 for preterm infants, and.88 versus.50 for term infants. For preterm infants, gestational age, admission illness severity, oxygenation index, anomalies, and small-for-gestational age status were significant predictors for LOV, accounting for 60% of the variance in the length of assisted ventilation. For term infants, oxygenation index and anomalies were significant predictors but only accounted for 29% of the variance. Considerable variation exists in the utilization of ventilator support among infants of closely related gestational age. In addition, a number of medical risk factors influence the need for, and length of, assisted ventilation. These models explain much of the variance in LOV among preterm infants but explain substantially less among term infants.neonatal intensive Care, assisted ventilation, Score for Neonatal Acute Physiology, resource consumption, prematurity.
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postdischarge utilization of medical services by high risk infants experience in a large Managed Care Organization
Pediatrics, 1996Co-Authors: Stevan Cavalier, Gabriel J. Escobar, Stephen A Fernbach, Charles P Quesenberry, Marie ChellinoAbstract:Background. Infants discharged from intensive Care nurseries are a high-risk infant (HRI) population known to have increased utilization of medical services. Most studies tracking HRIs have been based on data obtained from individual chart review or direct patient contact. Given the high cost of such studies, it is desirable to develop less costly methods to track such infants. Objectives. Our goals were: (1) to identify an HRI cohort at two neonatal intensive Care units; (2) to identify a control group of infants not meeting HRI criteria; and (3) to measure outpatient and inpatient utilization in both cohorts using computerized files in a Managed Care Organization. Methods. Using California Children9s Services criteria as our starting point, we established an HRI definition. From a 1-year birth cohort of 7579 infants at two facilities, we identified 250 infants meeting the HRI definition at two neonatal intensive Care units during 1990. We then matched the HRIs with a cohort of 896 randomly selected control newborns (those not meeting the HRI definition). Using Organizational computer files and state of California death certificate tapes, we followed these infants until February 28, 1992. We measured the number of hospitalizations, total number of hospital days, and total number of outpatient visits and expressed these outcomes as rates per person-year. We also measured postdischarge mortality. Results. The rate of hospitalization in the HRI group was 6.07 times (95% confidence interval [CI], 4.74-7.77) that in the control group. The utilization of hospital days by the HRI population (hospital days per 1000 person-months) was 13.24 times higher (95% CI, 11.00-16.04). The outpatient visit rate was 1.40 times higher (95% CI, 1.36-1.45) in the HRI population. Conclusion. Our findings in a large Managed Care Organization corroborate previous studies showing that hospitalization rates are significantly higher among HRIs. In our study population, outpatient utilization was significantly higher as well. Our study also demonstrates the feasibility of using computerized files to study outcomes in selected pediatric populations. These methods can be used for epidemiologic studies, interventional trials, and planning for resource allocation.
Raymond G Boyle - One of the best experts on this subject based on the ideXlab platform.
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specific food intake fat and fiber intake and behavioral correlates of bmi among overweight and obese members of a Managed Care Organization
International Journal of Behavioral Nutrition and Physical Activity, 2006Co-Authors: Jennifer A Linde, Robert W Jeffery, Nicolaas P Pronk, Jennifer Utter, Nancy E Sherwood, Raymond G BoyleAbstract:Background: The study examined correlates of body mass index (BMI) in overweight and obese members of a Managed Care Organization seeking treatment for obesity. It assessed intake of specific foods, dietary fat or fiber, and behaviors attempted to control weight. Methods: Participants were 508 men and 1293 women who were > 18 years and had a self-reported BMI > 27.0. This paper reports analyses of baseline and 24-month follow-up data from a randomized weight-loss trial. Cross-sectional and prospective relationships between BMI and behaviors were examined with regression analyses controlling for age and education. Results: At baseline, hamburger and beef consumption were associated with higher BMI for men; for women, hamburger, fried chicken, hot dog, bacon or sausage, egg, French fry, and overall fat consumption were associated with higher BMI, while eating high fiber cereal, fruit, and overall fiber intake were associated with lower BMI. Virtually all forms of weight control behavior were reported more often in heavier people. Subscribing to exercise magazines, however, was associated with lower BMI. Decreased fat intake and increased fruit/vegetable/fiber intake over the course of the study were associated with reductions in BMI at 24 months. Conclusion: The same behaviors that differentiate individuals with different body weight in the general population also differentiate between individuals of different body weights at the high end of the weight distribution. Educational efforts aimed at preventing weight gain and reducing obesity might benefit from focusing on specific foods known to be associated empirically with body weight and weight change over time.
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the relationship between prevalence and duration of weight loss strategies and weight loss among overweight Managed Care Organization members enrolled in a weight loss trial
International Journal of Behavioral Nutrition and Physical Activity, 2006Co-Authors: Jennifer A Linde, Darin J Erickson, Robert W Jeffery, Nicolaas P Pronk, Raymond G BoyleAbstract:Background Many adults in the United States report engaging in weight loss behaviors. The current study examined weight loss strategies among Managed Care Organization members, to determine the prevalence and impact of weight loss behaviors in this population. We hypothesized that greater engagement in weight loss strategies would be associated with greater weight loss success.
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professional advice and readiness to change behavioral risk factors among members of a Managed Care Organization
The American Journal of Managed Care, 2001Co-Authors: Patrick J Oconnor, Nicolaas P Pronk, William A Rush, J O Prochaska, Raymond G BoyleAbstract:OBJECTIVE To ascertain factors related to readiness to change behavioral risk factors in members of a Managed Care Organization (MCO). STUDY DESIGN Cross-sectional study. PATIENTS AND METHODS A telephone survey reached 4667 (73%) of 6409 adult members of a Minnesota MCO attending 2 primary Care clinics. Of these, 3826 members (82%) completed an interview designed to identify behavioral risk factors (smoking, consuming a high-fat diet, and physical inactivity) and readiness to change these behaviors. RESULTS Among MCO members consuming a high-fat diet, those most ready to change were older, were women, used more preventive services, and reported receiving professional advice about diet. For physical inactivity, those most ready to change were younger, women, and more educated; used more preventive services; and reported receiving professional advice about physical activity. Among smokers, those with higher readiness to change smoked fewer than 15 cigarettes a day, had higher self-efficacy, had no other smokers in the household, and reported receiving professional advice about smoking. After controlling for demographic variables and for use of preventive services, greater readiness to change for smoking (beta = 0.336, odds ratio [OR] = 1.40, P = .056), physical activity (beta = 0.651, OR = 1.92, P < .001), and diet (beta = 0.532, OR = 1.70, P < .001) was associated with having received professional advice to change these behaviors. CONCLUSIONS Levels of readiness to change behaviors in MCO members who smoke, are inactive, or consume high-fat diets are similar to those reported in other populations. The association of professional advice to change behaviors with increased readiness to change for smoking, physical activity, and diet suggests that receiving professional advice on these topics might assist patients in changing adverse health-related behaviors.
Nicolaas P Pronk - One of the best experts on this subject based on the ideXlab platform.
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specific food intake fat and fiber intake and behavioral correlates of bmi among overweight and obese members of a Managed Care Organization
International Journal of Behavioral Nutrition and Physical Activity, 2006Co-Authors: Jennifer A Linde, Robert W Jeffery, Nicolaas P Pronk, Jennifer Utter, Nancy E Sherwood, Raymond G BoyleAbstract:Background: The study examined correlates of body mass index (BMI) in overweight and obese members of a Managed Care Organization seeking treatment for obesity. It assessed intake of specific foods, dietary fat or fiber, and behaviors attempted to control weight. Methods: Participants were 508 men and 1293 women who were > 18 years and had a self-reported BMI > 27.0. This paper reports analyses of baseline and 24-month follow-up data from a randomized weight-loss trial. Cross-sectional and prospective relationships between BMI and behaviors were examined with regression analyses controlling for age and education. Results: At baseline, hamburger and beef consumption were associated with higher BMI for men; for women, hamburger, fried chicken, hot dog, bacon or sausage, egg, French fry, and overall fat consumption were associated with higher BMI, while eating high fiber cereal, fruit, and overall fiber intake were associated with lower BMI. Virtually all forms of weight control behavior were reported more often in heavier people. Subscribing to exercise magazines, however, was associated with lower BMI. Decreased fat intake and increased fruit/vegetable/fiber intake over the course of the study were associated with reductions in BMI at 24 months. Conclusion: The same behaviors that differentiate individuals with different body weight in the general population also differentiate between individuals of different body weights at the high end of the weight distribution. Educational efforts aimed at preventing weight gain and reducing obesity might benefit from focusing on specific foods known to be associated empirically with body weight and weight change over time.
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the relationship between prevalence and duration of weight loss strategies and weight loss among overweight Managed Care Organization members enrolled in a weight loss trial
International Journal of Behavioral Nutrition and Physical Activity, 2006Co-Authors: Jennifer A Linde, Darin J Erickson, Robert W Jeffery, Nicolaas P Pronk, Raymond G BoyleAbstract:Background Many adults in the United States report engaging in weight loss behaviors. The current study examined weight loss strategies among Managed Care Organization members, to determine the prevalence and impact of weight loss behaviors in this population. We hypothesized that greater engagement in weight loss strategies would be associated with greater weight loss success.
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professional advice and readiness to change behavioral risk factors among members of a Managed Care Organization
The American Journal of Managed Care, 2001Co-Authors: Patrick J Oconnor, Nicolaas P Pronk, William A Rush, J O Prochaska, Raymond G BoyleAbstract:OBJECTIVE To ascertain factors related to readiness to change behavioral risk factors in members of a Managed Care Organization (MCO). STUDY DESIGN Cross-sectional study. PATIENTS AND METHODS A telephone survey reached 4667 (73%) of 6409 adult members of a Minnesota MCO attending 2 primary Care clinics. Of these, 3826 members (82%) completed an interview designed to identify behavioral risk factors (smoking, consuming a high-fat diet, and physical inactivity) and readiness to change these behaviors. RESULTS Among MCO members consuming a high-fat diet, those most ready to change were older, were women, used more preventive services, and reported receiving professional advice about diet. For physical inactivity, those most ready to change were younger, women, and more educated; used more preventive services; and reported receiving professional advice about physical activity. Among smokers, those with higher readiness to change smoked fewer than 15 cigarettes a day, had higher self-efficacy, had no other smokers in the household, and reported receiving professional advice about smoking. After controlling for demographic variables and for use of preventive services, greater readiness to change for smoking (beta = 0.336, odds ratio [OR] = 1.40, P = .056), physical activity (beta = 0.651, OR = 1.92, P < .001), and diet (beta = 0.532, OR = 1.70, P < .001) was associated with having received professional advice to change these behaviors. CONCLUSIONS Levels of readiness to change behaviors in MCO members who smoke, are inactive, or consume high-fat diets are similar to those reported in other populations. The association of professional advice to change behaviors with increased readiness to change for smoking, physical activity, and diet suggests that receiving professional advice on these topics might assist patients in changing adverse health-related behaviors.
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systems approach to childhood and adolescent obesity prevention and treatment in a Managed Care Organization
International Journal of Obesity, 1999Co-Authors: Nicolaas P Pronk, Jackie L BoucherAbstract:OBJECTIVE: To outline an intervention approach to childhood and adolescent obesity prevention and treatment, that will systematically facilitate effective communication, provide long-term social support and access to resources, that may be accessed proactively or on demand. Furthermore, this approach operates in an environment that involves all critical parties: child/adolescent, family-unit, physician and allied health professionals. SYSTEMS THINKING APPROACH: The objective is to bring together all key stakeholders and consider the interrelationships among them as a common process. In a Managed Care setting, this may be accomplished by optimizing the contributions of Care delivery, health promotion and information systems. SETTING: A not-for-profit, community governed Managed Care Organization (MCO) in the Midwestern United States. Telephone-based, centralized services facilitate a process of access, communication, documentation and intervention implementation. CASE STUDIES:Two case studies are presented as examples of how access is obtained, the intervention is tailored to individual needs, communication is established, documentation is organized and long-term support is facilitated. CONCLUSIONS: A systems thinking approach to obesity prevention and treatment in youth has great potential. In a MCO setting, such an approach may be implemented, since integrated health Care delivery systems may allow a common process to be established that can bring together all key stakeholders.
Jennifer A Linde - One of the best experts on this subject based on the ideXlab platform.
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specific food intake fat and fiber intake and behavioral correlates of bmi among overweight and obese members of a Managed Care Organization
International Journal of Behavioral Nutrition and Physical Activity, 2006Co-Authors: Jennifer A Linde, Robert W Jeffery, Nicolaas P Pronk, Jennifer Utter, Nancy E Sherwood, Raymond G BoyleAbstract:Background: The study examined correlates of body mass index (BMI) in overweight and obese members of a Managed Care Organization seeking treatment for obesity. It assessed intake of specific foods, dietary fat or fiber, and behaviors attempted to control weight. Methods: Participants were 508 men and 1293 women who were > 18 years and had a self-reported BMI > 27.0. This paper reports analyses of baseline and 24-month follow-up data from a randomized weight-loss trial. Cross-sectional and prospective relationships between BMI and behaviors were examined with regression analyses controlling for age and education. Results: At baseline, hamburger and beef consumption were associated with higher BMI for men; for women, hamburger, fried chicken, hot dog, bacon or sausage, egg, French fry, and overall fat consumption were associated with higher BMI, while eating high fiber cereal, fruit, and overall fiber intake were associated with lower BMI. Virtually all forms of weight control behavior were reported more often in heavier people. Subscribing to exercise magazines, however, was associated with lower BMI. Decreased fat intake and increased fruit/vegetable/fiber intake over the course of the study were associated with reductions in BMI at 24 months. Conclusion: The same behaviors that differentiate individuals with different body weight in the general population also differentiate between individuals of different body weights at the high end of the weight distribution. Educational efforts aimed at preventing weight gain and reducing obesity might benefit from focusing on specific foods known to be associated empirically with body weight and weight change over time.
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the relationship between prevalence and duration of weight loss strategies and weight loss among overweight Managed Care Organization members enrolled in a weight loss trial
International Journal of Behavioral Nutrition and Physical Activity, 2006Co-Authors: Jennifer A Linde, Darin J Erickson, Robert W Jeffery, Nicolaas P Pronk, Raymond G BoyleAbstract:Background Many adults in the United States report engaging in weight loss behaviors. The current study examined weight loss strategies among Managed Care Organization members, to determine the prevalence and impact of weight loss behaviors in this population. We hypothesized that greater engagement in weight loss strategies would be associated with greater weight loss success.
Alexandra Wilson - One of the best experts on this subject based on the ideXlab platform.
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Neonatal Assisted Ventilation: Predictors, Frequency, and Duration in a Mature Managed Care Organization
Pediatrics, 2000Co-Authors: Alexandra Wilson, Mary Anne Armstrong, Marla N. Gardner, Bruce F. Folck, Gabriel J. EscobarAbstract:Objectives. Reference data are lacking on the frequency and duration of assisted ventilation in neonates. This information is essential for determining resource needs and planning clinical trials. As mortality becomes uncommon, ventilator utilization is increasingly used as a measure for assessing therapeutic effect and quality of Care in intensive Care medicine. Valid comparisons require adjustments for differences in a patient9s baseline risk for assisted ventilation and prolonged ventilator support. The aims of this study were to determine the frequency and length of ventilation (LOV) in preterm and term infants and to develop models for predicting the need for assisted ventilation and length of ventilator support. Methods. We performed a retrospective, population-based cohort study of 77 576 inborn live births at 6 Northern California hospitals with level 3 intensive Care nurseries in a group-model Managed Care Organization. The gestational age-specific frequency and duration of assisted ventilation among surviving infants was determined. Multivariable regression was performed to determine predictors for assisted ventilation and LOV. Results. Of 77 576 inborn live births in the study, 11 199 required admission to the neonatal intensive Care unit and of these, 1928 survivors required ventilator support. The proportion of infants requiring assisted ventilation and the median LOV decreased markedly with increasing gestational age. In addition to gestational age, admission illness severity, 5-minute Apgar scores, presence of anomalies, male sex, and white race were important predictors for the need for assisted ventilation. The ability of the models to predict need for ventilation was high, and significantly better than birth weight alone with an area under the receiver operating characteristic curve of .90 versus .70 for preterm infants, and .88 versus .50 for term infants. For preterm infants, gestational age, admission illness severity, oxygenation index, anomalies, and small-for-gestational age status were significant predictors for LOV, accounting for 60% of the variance in the length of assisted ventilation. For term infants, oxygenation index and anomalies were significant predictors but only accounted for 29% of the variance. Conclusions. Considerable variation exists in the utilization of ventilator support among infants of closely related gestational age. In addition, a number of medical risk factors influence the need for, and length of, assisted ventilation. These models explain much of the variance in LOV among preterm infants but explain substantially less among term infants. neonatal intensive Care, assisted ventilation, Score for Neonatal Acute Physiology, resource consumption, prematurity.
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Neonatal assisted ventilation: predictors, frequency, and duration in a mature Managed Care Organization.
Pediatrics, 2000Co-Authors: Alexandra Wilson, Mary Anne Armstrong, Marla N. Gardner, Bruce F. Folck, Gabriel J. EscobarAbstract:Reference data are lacking on the frequency and duration of assisted ventilation in neonates. This information is essential for determining resource needs and planning clinical trials. As mortality becomes uncommon, ventilator utilization is increasingly used as a measure for assessing therapeutic effect and quality of Care in intensive Care medicine. Valid comparisons require adjustments for differences in a patient's baseline risk for assisted ventilation and prolonged ventilator support. The aims of this study were to determine the frequency and length of ventilation (LOV) in preterm and term infants and to develop models for predicting the need for assisted ventilation and length of ventilator support. We performed a retrospective, population-based cohort study of 77 576 inborn live births at 6 Northern California hospitals with level 3 intensive Care nurseries in a group-model Managed Care Organization. The gestational age-specific frequency and duration of assisted ventilation among surviving infants was determined. Multivariable regression was performed to determine predictors for assisted ventilation and LOV. Of 77 576 inborn live births in the study, 11 199 required admission to the neonatal intensive Care unit and of these, 1928 survivors required ventilator support. The proportion of infants requiring assisted ventilation and the median LOV decreased markedly with increasing gestational age. In addition to gestational age, admission illness severity, 5-minute Apgar scores, presence of anomalies, male sex, and white race were important predictors for the need for assisted ventilation. The ability of the models to predict need for ventilation was high, and significantly better than birth weight alone with an area under the receiver operating characteristic curve of.90 versus.70 for preterm infants, and.88 versus.50 for term infants. For preterm infants, gestational age, admission illness severity, oxygenation index, anomalies, and small-for-gestational age status were significant predictors for LOV, accounting for 60% of the variance in the length of assisted ventilation. For term infants, oxygenation index and anomalies were significant predictors but only accounted for 29% of the variance. Considerable variation exists in the utilization of ventilator support among infants of closely related gestational age. In addition, a number of medical risk factors influence the need for, and length of, assisted ventilation. These models explain much of the variance in LOV among preterm infants but explain substantially less among term infants.neonatal intensive Care, assisted ventilation, Score for Neonatal Acute Physiology, resource consumption, prematurity.
