Studying the Vermont Oxford Network Annual Report every Autumn was a delight for me starting back in the 1990’s (the “phone book”). The information provided by Dr. Horbar and his talented colleagues always coalesced into that desirable admixture of anticipation, surprise, and wonder.
Nothing then, and nothing now in the VON summary is more (one word cannot capture this) perplexing/enduring/worthwhile/astounding than the variance among participant NICUs in the total hospital length of stay for very low birth weight infants. Just my opinion. How can it be that similar gestational age NICU entrants later exit the NICU at time length differences of several weeks? And differences would mysteriously persist year-after-year between NICUs……..
If there is any single item in the VON summary that deserves more reasoned (multidisciplinary) scrutiny, yet gets less, you’ll have to show me. It’s analogous to the six categories of healthcare waste – failure to provide evidence based care,….overuse of unproven care,.…poor care coordination,….fraud,.…price irregularities,….administration costs. The biggest “waste” category is the one which receives minimal rigorous study – administration costs.
Our AoW listserv colleague Dr. Billimoria and her colleagues led by Dr. Goldin have published a fascinating analysis of length of stay in 43 NICUs over six years. Huge variation, not clear why,……authors conclude – “These data reveal the need to identify best practices in NICUs that consistently
discharge infants more efficiently. Once these best practices are known, they can be disseminated to offer guidance in creating quality improvement projects…” Understatement.
Also attached is the thoughtful commentary from John Zupancic and colleagues.
More on NICU length of stay coming,……it is an increasingly urgent population health management issue for healthcare payers and families.
https://pubmed.ncbi.nlm.nih.gov/32699067/
https://pubmed.ncbi.nlm.nih.gov/32699068/
Joe Kaempf, MD
District VIII Member Extraordinaire
Portland, OR
Volume 12, Number 42