title: Hospital Variations in Unexpected Complications Among Term Newborns.
abstract: OBJECTIVE
  To examine contributing factors and potential reasons for hospital differences in unexpected newborn complication rates in Florida.
  
  
  METHODS
  We conducted a population-based retrospective cohort study of linked birth certificate and hospital discharge records from 2004 to 2013. The study population included 1 604 774 term, singleton live births in 124 hospitals. Severe and moderate complications were identified via a published algorithm. Logistic mixed-effects models were used to examine risk factors for complications and to estimate the percentage of hospital variation explained by factors. Descriptive analyses were performed to explore reasons for the differences.
  
  
  RESULTS
  Hospital total complication rates varied from 6.7 to 98.6 per 1000 births. No correlation between severe and moderate complication rates by hospital was identified. Leading risk factors for complications included medically indicated early-term delivery, no prenatal care, nulliparity, prepregnancy obesity, tobacco use, and delivery in southern Florida hospitals. Hospital factors such as geographic location, level of care or birth volume, and Medicaid births percentage explained 35% and 27.8% of variation in severe and moderate complication rates, respectively. Individual factors explained an additional 6% of variation in severe complication rates. Different complication subcategories (eg, infections, hospital transfers) drove the hospital factors that contributed to severe and moderate complications.
  
  
  CONCLUSIONS
  Variation in unexpected complication rates is more likely to be related to hospital rather than patient characteristics in Florida. The high proportion of variation explained by hospital factors suggests potential opportunities for improvement, and identifying specific complication categories may provide focus areas. Some of the opportunities may be related to differences in hospital coding practice.
authors.affiliation: Departments of Epidemiology & Biostatistics and yuri.sebastiao@nationwidechildrens.org.|Center for Surgical Outcomes Research, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio.
authors.forename: Yuri V
authors.initials: YV
authors.lastname: Sebastião
authors.affiliation: Departments of Epidemiology & Biostatistics and.
authors.forename: Lindsay S
authors.initials: LS
authors.lastname: Womack
authors.affiliation: Community & Family Health, College of Public Health.|Department of Mental Health Law & Policy, College of Behavioral & Community Sciences.
authors.forename: Humberto
authors.initials: H
authors.lastname: López Castillo
authors.affiliation: Departments of Pediatrics and.
authors.forename: Maya
authors.initials: M
authors.lastname: Balakrishnan
authors.affiliation: Obstetrics & Gynecology, Morsani College of Medicine.
authors.forename: Karen
authors.initials: K
authors.lastname: Bruder
authors.affiliation: Departments of Epidemiology & Biostatistics and.
authors.forename: Paige
authors.initials: P
authors.lastname: Alitz
authors.affiliation: Lawton & Rhea Chiles Center for Healthy Mothers & Babies.
authors.forename: Linda A
authors.initials: LA
authors.lastname: Detman
authors.affiliation: Lawton & Rhea Chiles Center for Healthy Mothers & Babies.
authors.forename: Emily A
authors.initials: EA
authors.lastname: Bronson
authors.affiliation: Faculty and Academic Affairs, USF Health, and.|Faculty and Academic Affairs, Morsani College of Medicine, University of South Florida, Tampa, Florida; and.
authors.forename: John S
authors.initials: JS
authors.lastname: Curran
authors.affiliation: Community & Family Health, College of Public Health.|Lawton & Rhea Chiles Center for Healthy Mothers & Babies.
authors.forename: William M
authors.initials: WM
authors.lastname: Sappenfield
mesh_terms: D000328:Adult; D002585:Cesarean Section; D015331:Cohort Studies; D005260:Female; D005431:Florida; D061847:Hospitals, High-Volume; D006801:Humans; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000453:epidemiology*; D007751:Labor, Induced; D008484:Medicaid / Q000706:statistics & numerical data; D009765:Obesity / Q000150:complications; D010298:Parity; D010360:Patient Transfer; D011247:Pregnancy; D011295:Prenatal Care; D012189:Retrospective Studies; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects; D047929:Term Birth; D014481:United States; D055815:Young Adult