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Effect of newborn screening for critical CHD on healthcare utilisation

Published online by Cambridge University Press:  02 July 2020

Rie Sakai-Bizmark Open the ORCID record for Rie Sakai-Bizmark [Opens in a new window] ,
Hiraku Kumamaru ,
Eliza J. Webber ,
Dennys Estevez ,
Laurie A. Mena ,
Emily H. Marr  and
Ruey-Kang R. Chang
Rie Sakai-Bizmark*
Affiliation:
Department of Pediatrics, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, USA Department of Pediatrics, Harbor-UCLA Medical Center and the David Geffen School of Medicine, University of California at Los Angeles, Torrance, CA, USA
Hiraku Kumamaru
Affiliation:
Department of Healthcare Quality Assessment, The University of Tokyo School of Medicine, Tokyo, Japan
Eliza J. Webber
Affiliation:
Department of Pediatrics, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, USA
Dennys Estevez
Affiliation:
Department of Pediatrics, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, USA
Laurie A. Mena
Affiliation:
Department of Pediatrics, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, USA
Emily H. Marr
Affiliation:
Department of Pediatrics, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, USA
Ruey-Kang R. Chang
Affiliation:
Department of Pediatrics, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, USA Department of Pediatrics, Harbor-UCLA Medical Center and the David Geffen School of Medicine, University of California at Los Angeles, Torrance, CA, USA
*
Author for correspondence: Rie Sakai-Bizmark, MD, PhD, MPH, Assistant Professor, Department of Pediatrics, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, David Geffen School of Medicine at UCLA, 1124 West Carson Street, Torrance, CA90502, USA. Tel: +1 (310) 222 3699; Fax: +1 (310) 222 4006. E-mail: rsakaibizmark@lundquist.org
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Abstract

Objective:

To evaluate the impact of state-mandated policies for pulse oximetry screening on healthcare utilisation, with a focus on use of echocardiograms.

Data sources/study setting:

Healthcare Cost and Utilisation Project, Statewide Inpatient Databases from 2008 to 2014 from six states.

Methods:

We defined pre- and post-mandate cohorts based on dates when pulse oximetry became mandated in each state. Linear segmented regression models for interrupted time series assessed associations between implementation of the screening and changes in rate of newborns with Critical CHD-negative echocardiogram results. We also evaluated the changes in rate of newborns who underwent echocardiogram but were not diagnosed with any health issues that could cause hypoxemia.

Results:

We identified 5967 critical CHD-negative echocardiograms (2847 and 3120 in the pre- and post-mandate periods, respectively). Our models detected a statistically significant increasing trend in rate of critical CHD-negative echocardiograms in the pre-mandate period (Incidence Rate Ratio: 1.08, p = 0.02), but did not detect any statistical differences in changes between pre- and post-mandate periods (Incidence Rate Ratio: 0.93, p = 0.14). Among non-Whites, an increasing trend of Critical CHD-negative echocardiogram during the pre-mandate period was detected (Incidence Rate Ratio 1.12, p < 0.01) and was attenuated during the post-mandate period (Incidence Rate Ratio 0.89, p = 0.02). Similar results were observed in the sensitivity analyses among both Whites and non-Whites.

Conclusions:

Results suggest that mandatory state screening policies are associated with reductions in false-positive screening rates for hypoxemic conditions, with reductions primarily attributed to trends among non-Whites.

Keywords

Critical CHDCHDhypoxemiamandated policynewborn
Type
Original Article
Information
Cardiology in the Young , Volume 30 , Issue 8 , August 2020 , pp. 1157 - 1164
Copyright
© The Author(s), 2020. Published by Cambridge University Press

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