The Dartmouth Atlas of Neonatal Intensive Care
Understanding the magnitude of under- and overuse of NICU care across regions and hospitals
Neonatal intensive care has successfully reduced newborn mortality and morbidity, but the quality, outcomes, and efficiency of care are incompletely documented and poorly understood. Depending simply on where they are born, newborns today face real, but invisible differences in their outcomes while payers (e.g. state Medicaid programs, insurance plans, and parents) face wide variations in costs. As a greater proportion of neonatal intensive care is provided to low-risk newborns, there is a pressing need to understand the magnitude of under- and overuse in care across regions and hospitals.
How we’re meeting it
The Dartmouth Atlas of Neonatal Intensive Care offers the first comprehensive examination of U.S. neonatal care across large populations of newborns, using data from the National Center for Health Statistics of the Centers for Disease Control (CDC), Texas Medicaid, and Anthem Blue Cross Blue Shield commercial and Medicaid plans. The findings from this work provide a unique assessment of the successes and shortcomings in medical care we are providing to our offspring.
Led by researchers at The Dartmouth Institute, the report raises questions about how medical care is provided to our nation’s newborns, particularly to those born premature or with other health problems.
"Regardless of the infant population we studied, newborn and NICU care varied markedly across regions and hospitals. Little of the variation was explained by differences in newborn health needs. The care that similar newborns receive is strikingly different in one hospital compared to another," said principal author David C. Goodman, MD, MS.
The report finds that the supply of neonatal intensive care beds grew 65 percent from 1995-2013. The supply of neonatologists grew even faster, increasing 75 percent from 1996- 2013. At the same time, the number of newborns has remained relatively stable. This has led to increasing numbers of lower risk newborns being admitted to NICUs.
The study also finds that the growth in NICU care has not occurred where it is most needed. Regions of the country with a high proportion of premature newborns, or other factors related to newborn illness, such as maternal education level or the rate of cesarean sections, are not the regions with higher supply of NICU beds or neonatologists.
Thirty years ago, the most common newborn admitted to a NICU was of low birth weight. In 2017, normal birthweight babies accounted for 48 percent of NICU admissions.
The report raises questions about the nation’s spending on perinatal care, among them:
- Is the NICU boom being driven by medical need or by competition among hospitals for newborns and the high margins they earn when some of those newborns are admitted to NICUs?
- Are mildly ill newborns receiving care they need and their families want, or is care induced by the increasing availability of NICU beds?
- Higher use of NICU care does not change the nation’s fundamental problem of poor newborn outcomes at the time of birth. Have we over invested in NICUs and under invested in women’s reproductive health services?