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Very preterm infants in Alberta: comparison of health technology service use, health outcomes and costs across five health zones

  • Author / Creator
    Tiggelaar, Sean M
  • Very Preterm Infants (VPI) (<1500g or below 32 weeks gestational age) account for only 5% of all births, but roughly half of all infant and perinatal mortality. Their high level of acuity requires extensive healthcare services during the first year of life, which result in long lengths of stay and the usage of neonatal intensive care units (NICUs). The objective of this study is to measure and compare mortality, length of stay, inpatient costs, and NICU utilization across Alberta’s health zones. The data came from the Alberta Perinatal Health Program’s comprehensive list of births in Alberta from 2004-2009. This data was merged with the Discharge Abstract Databases and several smaller databases in order to retrospectively examine costs, health outcomes, and service usage of infants born or admitted to any Albertan hospital. Nonlinear regression was used to assess temporal and inter-health-region mortality rates, and a negative binomial regression was used for length of stay data. Length of stay variation by health zone had little clinical significance, but differences in mortality rates and service utilization were significant and widely apparent. One year mortality rates between Calgary and Edmonton were 11.6% and 15.4% respectively, with Calgary having much lower mortality rates in infants at extremely low gestational ages (<25 weeks). 82.3% of VPI were born as recommended at a level three NICU facility, with 6.5% being transferred from lower level hospitals. The yearly total inpatient costs (2009 $ values) for VPI were $52 million, which averaged to $94,000 per VPI, with significant variation between health zones. The study found the current NICU allocation in Alberta to be allocatively efficient when evaluated on accessibility and bed limitations. However, statistically significant findings indicate metro locations such as Calgary and Edmonton have lower mortality rates (p<0.05). Future research should further explore the observed metropolitan protective relationship, and the potential role differing clinical practices in each health zone have on health outcomes and costs.

  • Subjects / Keywords
  • Graduation date
    2016-06
  • Type of Item
    Thesis
  • Degree
    Master of Science
  • DOI
    https://doi.org/10.7939/R3QB9VH09
  • License
    This thesis is made available by the University of Alberta Libraries with permission of the copyright owner solely for non-commercial purposes. This thesis, or any portion thereof, may not otherwise be copied or reproduced without the written consent of the copyright owner, except to the extent permitted by Canadian copyright law.
  • Language
    English
  • Institution
    University of Alberta
  • Degree level
    Master's
  • Department
    • School of Public Health
  • Specialization
    • Health Technology Assessment
  • Supervisor / co-supervisor and their department(s)
    • Nguyen, Thanh (School of Public Health)
    • Kaul, Padma (Department of Medicine)
    • Ohinmaa, Arto (School of Public Health)
  • Examining committee members and their departments
    • Toye, Jennifer (Department of Pediatrics)
    • Menon, Devidas (Health Technology and Policy Unit)