Children's Health

Two approaches hold promise for lowering U.S. infant mortality rates, which are particularly high for minority infants

The United States has one of the highest infant mortality rates among industrialized countries. Two approaches hold promise for improving U.S. infant mortality rates, suggests a study supported by the Agency for Healthcare Research and Quality (HS13371 and HS10858).

Jeannette A. Rogowski, Ph.D., of the University of Medicine and Dentistry of New Jersey and her colleagues used 1994-2000 data from a collaborative network of neonatal intensive care units (NICUs) in 49 States and 22 countries (the Vermont Oxford Network, VON) to assess the potential of collaborative quality improvement and selective referral to improve the quality of neonatal care. The collaborative approach systematically identifies "best practices" being used in hospitals with the best outcomes and then encourages the adoption of these practices at all hospitals.

By 2000, the VON database included about half of all very-low-birthweight (VLBW; less than 3.5 pounds) infants born in the United States and 40 percent of the Nation's NICUs. Analysis of VON data revealed a mortality rate (adjusted for patient risk factors) ranging from 9 percent for low-mortality hospitals to 15 percent for high-mortality hospitals. The investigators calculated that if all hospitals were to achieve the rate of the best-performing quintile (9 percent), then the overall mortality rate for all infants would fall 24 percent. The decline would likely be greater for minority infants, who are more likely to be VLBW and to be cared for at hospitals with poor outcomes.

The evidence-based selective referral approach relies on consumer choice and competition among health care providers based on public reporting of quality information. In one study, the difference in mortality rates between hospitals ranked in the best and worst quintiles was more than 5 times as large when hospitals were ranked on past mortality rates (9 vs. 19 percent) than when they were ranked on past NICU patient volume (13 vs. 15 percent). The researchers conclude that more lives could be saved if referrals were based on infant outcome data, as routinely collected by the VON, rather than high NICU volume.

See "Variations in the quality of care for very-low-birthweight infants: Implications for policy," by Dr. Rogowski, Douglas O. Staiger, Ph.D., and Jeffrey D. Horbar, M.D., in the September 2004 Health Affairs 23(5), pp. 88-97.

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