O0699 Oct.3: 4:25pm - Evaluating Care in Safety Net Hospitals: Clinical Outcomes and NICU Quality of Care in California

Background: The factors that underlie racial and ethnic disparities in care and outcomes among very low birth weight (VLBW; ≤ 1,500 grams) infants remain unclear. Site of care may be a key driver of disparities due to variations in hospital performance and quality of care. This study examines the characteristics of NICUs from safety net and non-safety net hospitals in California and the extent to which site of care is associated with racial/ethnic disparities.

Methods: We studied 24,799 VLBW infants born at 139 California hospitals from 2014-2018. Safety net hospitals were identified by starting with a list of county and public hospitals and narrowing down to those with >75% of patients on Medi-Cal (California’s Medicaid program) and sufficient numbers of VLBW infants through linkage to the California Perinatal Quality Care Collaborative (CPQCC) and California Maternal Quality Care Collaborative (CMQCC) databases. Public hospitals, defined in this study as the University of California hospital systems, were analyzed separately from county safety net hospitals. We examined distribution of births by race/ethnicity across hospital types using the Kolmogorov-Smirnov test to compare Hispanic, Non-Hispanic Black, Asian/Pacific Islander, Other Race/Ethnicity, and All Minorities to Non-Hispanic White VLBW infants. We calculated risk adjusted rates of survival without major morbidity and infant mortality and compared quality of care using Baby-MONITOR scores, a composite indicator of NICU quality.

Results: We found significant differences in the distributions across safety net and non-safety net hospitals. Safety net hospitals care for higher concentrations of non-White infants, in particular non-Hispanic Black and Hispanic patients [Table 1]. Despite their higher concentration of Medi-Cal patients, safety net hospitals performed similarly in evaluations of NICU quality of care and infant survival without major morbidity compared to public hospitals and other non-safety net hospitals. However, there was a small but significant difference in risk-adjusted infant mortality rates between safety net 7.2[6.4-8.1] per 100 infants) and other non-safety net CPQCC hospitals (5.8[5.4-6.2] per 100 infants) [Table 2]. This difference was driven by higher mortality rates in a small subset of safety net hospitals.

Conclusions: In California, birth in safety net hospitals is not associated with racial/ethnic disparities in quality of care or survival without major morbidity, but with an increase in neonatal mortality rate among non-White infants.