Texas Neonatal Intensive Care Project
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 Texas Neonatal Intensive Care Project is the first large scale population-based study of Medicaid-insured newborn and neonatal intensive care in the U.S. This study provides rich descriptions of patterns of newborn care and spending across all levels of illness severity for a diverse population: 60% of NICU admissions in Texas are Medicaid; of these newborns, 60% of their mothers are Hispanic. Researchers at The Dartmouth Institute are also examining the relationship between care patterns and outcomes during the first year of life. The project links natality and mortality data with Medicaid claims files to develop a retrospective cohort with 1.13 million newborns that begins at birth and continues for a year. The data covers the time in which the newborn was inpatient in a hospital or medical facility and after discharge home. Newborns are assigned to neonatal intensive care regions and hospitals to reveal differing patterns of care. Novel patient-level statistical models have estimated risk adjustment scores to control for differences in illness severity. Initial findings show a strikingly high degree of variation of care patterns with relatively little of the variation explained by differences in newborn risk. The findings from this work will join together with studies of three other newborn populations to provide a unique assessment of the successes and shortcomings in medical care we are providing to our offspring.