Neonatologist staffing is related to the inter-hospital variation of risk-adjusted mortality of very low birth weight infants in Korea
This study investigated whether hospital factors, including patient volume, unit level, and neonatologist staffing, were associated with variations in standardized mortality ratios (SMR) adjusted for patient factors in very-low-birth-weight infants (VLBWIs). A total of 15,766 VLBWIs born in 63 hospitals between 2013 and 2020 were analyzed using data from the Korean Neonatal Network cohort. SMRs were evaluated after adjusting for patient factors. High and low SMR groups were defined as hospitals outside the 95% confidence limits on the SMR funnel plot. The mortality rate of VLBWIs was 12.7%. The average case-mix SMR was 1.1; calculated by adjusting for six significant patient factors: antenatal steroid, gestational age, birth weight, sex, 5-min Apgar score, and congenital anomalies. Hospital factors of the low SMR group (N = 10) had higher unit levels, more annual volumes of VLBWIs, more number of neonatologists, and fewer neonatal intensive care beds per neonatologist than the high SMR group (N = 13). Multi-level risk adjustment revealed that only the number of neonatologists showed a significant fixed-effect on mortality besides fixed patient risk effect and a random hospital effect. Adjusting for the number of neonatologists decreased the variance partition coefficient and random-effects variance between hospitals by 11.36%. The number of neonatologists was independently associated with center-to-center differences in VLBWI mortality in Korea after adjustment for patient risks and hospital factors.
Authors
- Yun Sil Chang (ORCID: https://orcid.org/0000-0001-9201-2938)
- Myung Hee Lee (ORCID: https://orcid.org/0000-0002-2909-4421)
- Jang Hoon Lee (ORCID: https://orcid.org/0000-0003-4765-9948)
Institutions
- Samsung Medical Center (KR)
- Biomedical Research Institute (US)
- Ajou University (KR)
- Sungkyunkwan University (KR)
Publication Details
- Journal
- Scientific Reports
- Published
- 2024-09-09
- DOI
- https://doi.org/10.1038/s41598-024-69680-1
- Citations
- 6
- Primary Topic
- Neonatal Respiratory Health Research
- Type
- article
- Field-Weighted Citation Impact
- 2.51
Funders
- Seoul National University Bundang Hospital
- Korea University Guro Hospital
- Konkuk University Medical Center
- National Research Foundation
- Hanyang University
- Jeju National University
- Chonbuk National University
- Chonnam National University
- Chosun University
- Chung-Ang University
- Chungnam National University
- Dankook University
- Dong-A University
- Dongguk University
- Eulji University
- Kangwon National University
- Keimyung University
- Konyang University
- Kosin University
- Kyungpook National University
- Pusan National University
- Seoul National University
- Soonchunhyang University
- Wonkwang University
- Gyeongsang National University
- Kyung Hee University
- Ajou University
- Ewha Womans University
- Gachon University
- Hallym University
- Inha University
- Inje University
- Konkuk University
- Korea University
- Catholic University of Korea
- Yeungnam University
- Chonbuk National University Hospital
- Gangneung Asan Hospital
- National Health Insurance Service
- National Research Foundation of Korea
- Seoul National University Hospital
- Kyungpook National University Hospital
- Chungnam National University Hospital
- Jeju National University Hospital
- Pusan National University Hospital
- CHA University
- Ministry of Science and ICT, South Korea
- Seoul Metropolitan Government Seoul National University Boramae Medical Center
- Korea University Anam Hospital
- Inha University Hospital
- Samsung
- Korea National Institute of Health
- Ulsan University Hospital
- Busan Paik Hospital, Inje University