Treatment of very low birth weight infants in a neonatal intensive care unit (NICU) can be expensive — particularly in rural areas — but may potentially reduce long-term treatment costs as well as improve short- and long-term health outcomes. The alternative to a prolonged NICU stay — early discharge with outpatient monitoring — is less expensive, but may also be associated with poorer health outcomes.
To date, few studies have looked at this trade-off. A multi-disciplinary team of investigators from Transylvania University, the University of Kentucky (UK) College of Public Health, UK College of Medicine, and the Wyoming Department of Health undertook an investigation to better understand the economic and health impact of NICU treatment of these infants. “Examining the Trade-off Between NICU Length of Stay and Postdischarge Monitoring: An Instrumental Variables Approach,” appears in the September 2018 issue of the Journal of Healthcare Management. The authors are: Dr. Geoffrey Williams, associate professor of economics, Transylvania University; Dr. Henrietta Bada, professor of pediatrics and health, behavior & society, UK College of Medicine and College of Public Health; Dr. Lorie Chesnut, epidemiologist, Wyoming Department of Health; Ms. Emily Ferrell, research assistant, UK College of Public Health; and Dr. Glen P. Mays, professor of health management and policy, UK College of Public Health.
Investigators employed an instrumental variables approach (fuzzy discontinuity) based on changes in practice for the treatment of very low birth weight infants in a perinatal referral center’s NICU during 2000 and 2001. The strategy of keeping infants in a NICU longer reduced the likelihood of discharge with an apnea/cardio monitor. The primary instrumental variables specification estimated that every additional 100 grams of discharge weight reduced the likelihood of discharge with an apnea/cardio monitor by 4.8 percent.
The researchers found that an infant’s length of stay in the NICU has important cost and health benefits. Greater expenses on days in the NICU are partially compensated by reduced monitoring post discharge. They conclude that “[i]n contexts where post-discharge monitoring is particularly difficult or expensive, extending length of stay may be cost-effective as well as potentially improve health outcomes.”