Modelling Neonatal Care Pathways For Babies Born Preterm: An Application Of Multistate Modelling.

Title

Modelling Neonatal Care Pathways For Babies Born Preterm: An Application Of Multistate Modelling.

Creator

Seaton SE; Barker L; Draper ES; Abrams KR; Modi N; Manktelow BN

Identifier

DOI: 10.1371/journal.pone.0165202

Publisher

Plos One

Date

2016

Subject

Time; Infant; Competing Risks; Premature Babies; Death; Multidisciplinary Sciences; Survival; Population; Length; Variables; Stay; Babies; Funding; Health Sciences; Data Analysis; Intensive Care; Collaboration

Description

Modelling length of stay in neonatal care is vital to inform service planning and the counselling of parents. Preterm babies, at the highest risk of mortality, can have long stays in neonatal care and require high resource use. Previous work has incorporated babies that die into length of stay estimates, but this still overlooks the levels of care required during their stay. This work incorporates all babies, and the levels of care they require, into length of stay estimates. Data were obtained from the National Neonatal Research Database for singleton babies born at 24-31 weeks gestational age discharged from a neonatal unit in England from 2011 to 2014. A Cox multistate model, adjusted for gestational age, was used to consider a baby's two competing outcomes: death or discharge from neonatal care, whilst also considering the different levels of care required: intensive care; high dependency care and special care. The probabilities of receiving each of the levels of care, or having died or been discharged from neonatal care are presented graphically overall and adjusted for gestational age. Stacked predicted probabilities produced for each week of gestational age provide a useful tool for clinicians when counselling parents about length of stay and for commissioners when considering allocation of resources. Multistate modelling provides a useful method for describing the entire neonatal care pathway, where rates of in-unit mortality can be high. For a healthcare service focussed on costs, it is important to consider all babies that contribute towards workload, and the levels of care they require.

Rights

Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).

Citation List Month

October 2016 List

Citation

Seaton SE; Barker L; Draper ES; Abrams KR; Modi N; Manktelow BN, “Modelling Neonatal Care Pathways For Babies Born Preterm: An Application Of Multistate Modelling.,” Pediatric Palliative Care Library, accessed August 3, 2021, https://pedpalascnetlibrary.omeka.net/items/show/10658.

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