Janet H. Muri, MBA

In the calendar year (CY) 2018, the NPIC Perinatal Center Data Base (PCDB) profiled 309,497 newborns across 80 hospitals. 91.5 % percent of those were born at the reporting hospitals, and 4.0 % were transferred in following delivery, presumably for a higher level of care. The 2018 rate of infants transferred in is unchanged from the CY 2017 rate.

In CY 2018, 15.5 % percent of total neonates were admitted to a special care nursery, whether to an intensive care or intermediate care bed. When NPIC isolated just those facilities that participated in the Trend Data Base for the previous five year period (2014-2018), the 2018 admission rate was 16.7%, reflecting a stable trend from the 16.1% for the same cohort of hospitals in 2014.

Below is a table that profiles key metrics from the NPIC Calendar Year 2018 Perinatal Center Data Base (PCDB) in comparison to CY 2017 and the NPIC Trend Data Bases for years 2013-2017 and 2014-2018.

Increased Attention on Special Care Admissions

As we stated in our review of CY 2017 Special Care statistics from the Perinatal Center Data Base (Neonatology Today, August 2018), the ultimate goal is to keep infants out of the special care nursery. While there will always be a need for neonatal special care services, greater payer scrutiny is likely to drive some decreases in admissions as well as external attention on unnecessary special care admissions as a quality of care issue.

The Joint Commission’s newest measure for the Perinatal Care Measure set is PC-06: Unexpected Complications in Term Newborns. (1) This measure must be reported by almost all hospitals with more than 300 deliveries annually and includes analysis of 100% of all newborn discharges starting with 1/1/2019 discharges. (This is a departure from other PC measures that permit sampling). The PC-06 denominator is all live-born single term newborns 2500 grams or over in birth weight, excluding those that have congenital anomalies, (1) pre-existing fetal conditions or indications of maternal substance abuse. Numerator cases reflect severe and moderate complications as defined by the TJC algorithm in consultation with the measure developer, the California Maternal Quality Care Collaborative. PC-06 is divided into an overall rate (PC-06.0), a severe rate (PC-06.1) and moderate rate (PC -06.2). The severe category includes infants transferred out to another acute care facility (for a higher level of care). Since not all transfers are for a higher level of care, TJC abstraction guidelines include the following language:

“For PC-06 Only: If a newborn is transferred to another acute care facility for purposes other than medical treatment or the need for a higher level of care, abstract allowable value 8 (not documented or unable to determine). Examples include: Newborn is transferred to another facility covered by their healthcare plan or for disaster evacuation.”

This qualifier will require hospitals to review their transferred out cases carefully to ensure only those meeting the measure definition are included in their numerator. On the positive side, the measure may also incentivize greater antepartum referral/transfer of high-risk pregnancies to the appropriate level of care.

References:

1. Source: Specification Manual for Joint Commission National Quality Measures v2018B1, www.jointcommission. org.