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Invited Commentary
Pediatrics
June 18, 2020

Using Neonatal Intensive Care Units More Wisely for At-Risk Newborns and Their Families

Author Affiliations
  • 1Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
  • 2Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
JAMA Netw Open. 2020;3(6):e205693. doi:10.1001/jamanetworkopen.2020.5693

Escalating US health care expenditures, including estimates that 20% to almost 50% of these costs involve processes, products, and services that do not improve outcomes, have brought renewed attention to the need to improve value in health care.1 Among the 6 waste categories outlined by Berwick and Hackbarth,1 there has been considerable focus on opportunities to reduce overtreatment, “the waste that comes from subjecting patients to care that… cannot possibly help them… rooted in outmoded habits, supply-driven behaviors, and ignoring science.”

Neonatal intensive care unit (NICU) services are at particularly high risk of overuse. Hospital and professional services reimbursements, reflecting the acute and highly technical nature of intensive care, are favorable and remain closely linked to admission volume and patient days in most regions. Both a legacy of intervention and a fear of litigation in caring for an at-risk population can also contribute to ineffective testing and treatments. The neonatology community is, however, starting to recognize the potential for improving care and controlling resource utilization. A 2015 study describing a systematic process to identify ineffective or harmful neonatal tests and treatments yielded a “Choosing Wisely Top Five” list in part to guide these efforts.2 In recent years, the neonatal care value literature has evolved to also focus more broadly on trends relating to NICU utilization—specifically, increasing admission rates and longer lengths of stay.

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