Neonatal intensive care unit report cards.

Abstract

* Abbreviations: ICU = : intensive care unit • NTISS = : Neonatal Therapeutic Intervention Scoring System • SNAP = : Score for Neonatal Acute Physiology • VLBW = : very low birth weight • NICU = : neonatal intensive care unit Severity of illness scores, based on deranged physiology, are used to compute the probability of the risk of death of severely ill patients. An original goal was to use these predictions to “provide a reproducible and empiric basis for decisions to forgo treatment.”1 This goal has not been realized.2–5 A second use of severity scores is to compare outcomes such as mortality rate between intensive care units (ICUs), physicians, or periods. By adjusting outcome rates for initial severity of illness at or soon after admission or birth (zero-time), the rates can be compared “on a level playing field.”6 The adjusted rates might be used as putative indicators of health care provider quality, or “report cards.”7 These could “inform revisions in health care financing and structure.”1 Richardson et al pioneered models of risk adjustment for neonates, based on therapeutic (Neonatal Therapeutic Intervention Scoring System [NTISS]) as well as pathophysiologic measures (Score for Neonatal Acute Physiology [SNAP]).8 They now report a reduction in risk-adjusted mortality rate of very low birth weight (VLBW) infants between 1989–1990 and 1995.9 The first outcome year … Address correspondence to Max Perlman, MB, BS, FRCP, Division of Neonatology, Department of Paediatrics, Hospital for Sick Children, 555 University Ave, Toronto, Ontario, Canada M5G 1X8.