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PEDIATRICS Vol. 112 No. 6 December 2003, pp. 1264-1273

Management of Hyperbilirubinemia in Newborns: Measuring Performance by Using a Benchmarking Model

Shu-Chiung Chou, PhD*, R. Heather Palmer, MB, BCh, SM, FAAP*, Sudhakar Ezhuthachan, MD, DCH, FAAP{ddagger}, Christine Newman, MS, RNC, CNNP{ddagger}, Brenna Pradell-Boyd, MM*, M. Jeffrey Maisels, MB, BCh, FAAP§ and Marcia A. Testa, MPH, PhD||

* Center for Quality of Care Research and Education, Harvard School of Public Health, Boston, Massachusetts
{ddagger} Henry Ford Health System, Detroit, Michigan
§ William Beaumont Hospital, Royal Oak, Michigan
|| Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts

Background. Accreditors hold hospitals accountable for harm from serious newborn hyperbilirubinemia, yet standards for evaluating performance in prevention are lacking.

Objective. We confirmed prognostic variables for newborn hyperbilirubinemia and developed a benchmarking model for self-evaluation of hyperbilirubinemia management.

Methods. We conducted a 3-year prospective cohort study in the Henry Ford Health System (HFHS) on 5507 healthy newborns of ≥35 weeks’ gestational age. HFHS follows a rigorous protocol for hyperbilirubinemia management. Defining hyperbilirubinemia as age-specific levels of total serum bilirubin exceeding American Academy of Pediatrics criteria for considering phototherapy and severe hyperbilirubinemia as total serum bilirubin ≥20 mg/dL, we used logistic and Poisson regressions to determine predictors and estimate parameters for a benchmarking model. We compared incidence rates for severe hyperbilirubinemia from HFHS to aggregate data from 11 hospitals reported to have less rigorous management.

Results. Newborns were 52.9% black, 14.4% white, 24.3% Latino, and 2.4% Asian; 30% were exclusively and 28% partially breastfed. Regression analyses revealed associations for hyperbilirubinemia and severe hyperbilirubinemia with black mothers (negative) and exclusive or partial breastfeeding and younger gestational age (positive). Male newborns and older mothers were also associated with severe hyperbilirubinemia. For all 5 variables, we found a lower risk for severe hyperbilirubinemia at HFHS than in the comparison hospital group. To compare hospitals, we developed a benchmarking model for incidence of hyperbilirubinemia adjusting for race, feeding method, and gestational age.

Conclusions. Hospitals with access to newborns’ inpatient and postdischarge data can use our benchmarking model to compare their management of hyperbilirubinemia with a reference population that received rigorous care.

Key Words: neonatal jaundice • clinical practice guideline • quality of health care • breastfeeding • evaluation

Abbreviations: TSB, total serum bilirubin • HCO, health care organization • JCAHO, Joint Commission on Accreditation of Healthcare Organizations • AAP, American Academy of Pediatrics • HFHS, Henry Ford Health System • HFH, Henry Ford Hospital • CDS, Corporate Data Stores • ER, emergency room • HFHSF babies, HFHS follow-up babies • O/E, observed events/expected events • SD, standard deviation

Received for publication Oct 28, 2002; Accepted Apr 7, 2003.




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