Evaluating Care in Safety Net Hospitals: Clinical Outcomes and NICU Quality of Care in California.

OBJECTIVES: To examine the characteristics of safety net (sn) and non-safety net neonatal intensive care units (NICUs) in California and whether the site of care is associated with clinical outcomes.

STUDY DESIGN: This population-based retrospective cohort study of 34 snNICUs and 104 non-snNICUs included 22,081 infants born between 2014-2018 with birth weights of 401-1500g or gestational ages of 22-29 weeks. Quality of care as measured by Baby-MONITOR score and rates of survival without major morbidity were compared between snNICUs and non-snNICUs.

RESULTS: Black and Hispanic infants were disproportionately cared for in snNICUs, where care and outcomes varied widely. We found no significant differences in Baby-MONITOR scores (snNICUs: z-score (SD) = -0.31 (1.3); non-snNICUs: 0.03 (1.1), P = 0.1). Among individual components, infants in snNICUs exhibited lower rates of human milk nutrition at discharge (-0.64 (1.0) vs. 0.27 (0.9)), lower rates of no healthcare associated infection (-0.27 (1.1) vs. 0.14 (0.9)) and higher rates of no hypothermia on admission (0.39 (0.7) vs. -0.25 (1.1)). We found small but significant differences in survival without major morbidity (Adjusted rate = 65.9% (63.9-67.9) for snNICUs vs. 68.3% (67.0-69.6) for non-snNICUs, p=0.02) and in some of its components; snNICUS had higher rates of necrotizing enterocolitis (3.8% (3.4-4.3) vs. 3.1% (2.8-3.4)) and mortality (7.1% (6.5-7.7) vs. 6.6% (6.2-7.0)).

CONCLUSIONS: Safety net NICUs achieved similar performance to non-snNICUs in quality of care, except for small but significant differences in any human milk at discharge, infection, hypothermia, necrotizing enterocolitis, and mortality.