Neonatal Health Services


The Children's Hospital of Philadelphia is a national leader in care for neonates and neonatal health services research.  Currently, neonatal and perinatal health services research at the Center for Outcomes Research focuses on three areas, all designed to answer questions about the underlying causes of variations in the outcomes and health care use of children.  These areas include socioeconomic status, specifically racial/ethnic identification; the quality of care at the treatment hospital and outpatient center; and the health care system.   Analyses occur at the patient level, public health level, and population level using population-based data to answer these questions. COR has experience using state-based maternal-newborn linked data, which link birth and death certificates to hospital data from the mother and child (over 10 million observations in a 15 year period); the Pediatric Hospital Inpatient System from CHCA; National Medicaid data; and Medicare records.  COR also has experience with the development and maintenance of longitudinal cohorts of prematurely-born infants.Listed below are ongoing or completed research projects conducted by by center investigators that focus on neonatal and perinatal health services.

Ongoing Projects

Impact of Pediatric Trauma Centers on Outcomes of Injured Children

Funded by the Agency for Healthcare Research and Quality
Principal Investigator: Scott A. Lorch, MD, MSCE

Injury is the most significant public health threat to children in the United States. However, a comprehensive and evidence-based approach to pediatric trauma management is lacking. The goal of this study is to identify the structures and processes of care that optimize outcomes of pediatric trauma patients. More Information

Effect of Changing NICU Patient Volumes and Levels of Care on Neonatal Outcomes

Funded by the National Institute of Health
Principal Investigator: Scott A. Lorch, MD, MSCE

Current literature shows that outcomes (mortality and serious morbidity) for high-risk neonates, especially extremely premature infants, are improved if infants are delivered at a hospital with a high-volume, tertiary-level neonatal intensive care unit (NICU). While the evidence suggests that neonatal care should be more “regionalized”, there is no information on how this process should occur. The goal of this study is to identify the structures and patient volumes needed to optimize the outcomes of premature infants, allowing for evidence-based policies at the state and national-level to guide the development of perinatal delivery systems.

NICU Care and Cost-Related Analyses

Funded by the Ohio Perinatal Quality Collaborative (OPQC)
Principal Investigator: Scott A. Lorch, MD, MSCE

The goal of this research is to evaluate statewide clinical quality improvement projects using a combination of prospectively collected data, and Medicaid claims data from children receiving care at any NICU in the state of Ohio. Analyses will include cost analysis, cost effectiveness analysis, and assessment of outcomes such as morbidity, mortality, and hospital readmission.

The Financing of Obstetrical Care in the U.S.

Funded by the Centers for Disease Control and Precention
Principal Investigator: Scott A. Lorch, MD, MSCE
The financing of obstetric care remains controversial. Obstetric care can be broken up into 3 areas:  prenatal care; intrapartum care; and postpartum care.  The vast amount of resources devoted to obstetric care centers on intrapartum care, with higher reimbursement typically for operative, or Cesarean section deliveries, compared to vaginal births.  Prenatal and postpartum care is funded through a variety of mechanisms, including bundled payments for the hospital and providers providing intrapartum care, specific prenatal or postpartum visit codes, or standard outpatient visit codes with a 1-5 scale of medical complexity. The aims of this project are to (1) describe the variation in obstetric funding across the United States, using Medicaid Physician Fee Schedules publicly available for 50 of 51 states (excluding Tennessee), (2) describe how these fee schedules changed in response to Medicaid Expansion and the enactment of the Affordable Care Act in the United States, and (3) identify the association between obstetric funding mechanisms, total compensation of health care providers by the Medicaid system per patient, delivery location, and neonatal outcomes using MAX data from 2007-2010.

Predicting and Preventing Pediatric Hospital Readmissions

Funded by the Agency for Healthcare Research and Quality
Principal Investigator: Scott A Lorch, MD, MSCE

The prevention of hospital readmissions, particularly preventable or unnecessary readmissions, has become an area of interest for public policy makers, health insurers, and providers. Medicare has begun a readmission reduction program to reduce payments to hospitals with higher-than-expected readmission rates.  A similar interest is seen in pediatric medicine.  While the estimated readmission rate within 30 days among the 2.4 million admissions annually in the United States is approximately 6.5%, many conditions such as surgery, sickle cell disease, and prematurity have rates between 15 and 20%. Children with publicly-financed insurance have higher rates of readmission, with rates of prematurely-born infants in some states as high as 30%. Most methods to predict the risk of readmission for both adult and pediatric patients frequently misclassify patients, thus the principal goal of this study is to develop a real-time predictor of readmission risk for pediatric patients.


Recently Completed Projects

Parental Trust and Racial Disparities in the Care of Discharged Premature Infants

Funded by the National Institute of Child Health and Human Development
Principal Investigator: Scott A. Lorch, MD, MSCE

Racial disparities continue to be a major impediment to the delivery of high quality health care to all patients.  This study is examining various underlying explanations for such disparities in the outcomes of care provided to premature infants in the first two years after discharge from the neonatal intensive care unit. By understanding these underlying explanations for the racial disparities in these outcomes, particularly families’ trust in the health care system, we can aid in the development of interventions to reduce these differences in care.

Impact of Obstetric Unit Closures on Pregancy Outcomes

Funded by the Agency for Healthcare Research and Quality
Principal Investigator: Scott A Lorch, MD, MSCE

Although over 4 million infants are delivered in the United States every year, the reduction of obstetric services through the closure of obstetric units is a common occurrence. This study is investigating the impact of obstetric unit closures on the pregnancy outcomes of both the larger community and the smaller community serviced by the closed obstetric unit. Improved understanding of the impact of such service reductions in the obstetric market will result in more efficient use of health care services and optimize the value of health care dollars spent on obstetric care. 

Evaluating Maternal and Neonatal Outcomes

Funded by a Health Resources and Services grant to the University of Pennsylvania
Principal Investigator:  Sindhu Srinivas, MD, MSCE; Co-investigator:  Scott A. Lorch, MD, MSCE

Over 4 million women give birth annually in the United States, making child birth one of the most common reasons for hospital care.  Provider and nurse staffing structure on labor and delivery units have recently received heightened attention as critical aspects of obstetric care delivery.  Prior to the widespread adoption of specific staffing models, rigorous research is needed to study the impact these structural aspects of obstetric care.  This project was evaluating structural aspects of obstetric care and their impact on processes of care and resultant maternal and neonatal outcomes.  

Scope of Services for Fetal Mortality:  Epidemiology and Performance Measurement

Funded by the Centers for Disease Control and Prevention
Principal Investigator:  Scott A. Lorch, MD, MSCE

Neonatal mortality rates have been proposed as a measure of the quality of neonatal care. There has been little validation of the correct metric for their use. The purpose of this project was to calculate several separate hospital mortality statistics to characterize fetal deaths and determine the importance of fetal deaths when using mortality as a measure of the performance of neonatal or perinatal care. 

Perinatal Regionalization and Quality of Care

Funded by the Agency for Healthcare Research and Quality
Principal Investigator:  Scott A. Lorch, MD, MSCE

Very-low-birth weight a significant public health concern. Regionalization policies have been developed to optimize the care of these high-risk newborns, but these policies have recently weakened in many areas of the U.S.  This study used an instrumental variables approach to evaluate differences in quality of care between hospitals and the effect of de-regionalization on outcomes. 

Infant Functional Status and Discharge Management

Funded by the Department of Health and Human Services Maternal and Child Health Bureau
Principal Investigator:  Jeffrey H. Silber, MD, PhD

This project developed a more optimal algorithm to support infant discharge decisions, based on the relationship between physiologic parameters reflecting infant functional status and total resource utilization associated with these discharge decisions. The main hypothesis tested was whether there exists a range of discharge algorithms in which longer hospital stays may result in reduced overall resource utilization. 

Aggregated Complication Measure for Neonatal Quality of Care

Funded by the Department of Health and Human Services Maternal and Child Health Bureau
Principal Investigator:  Scott A. Lorch, MD, MSCE

Improved measures of neonatal quality will help facilitate initiatives to lower costs and improve the quality of neonatal care by reducing unnecessary morbidity and mortality in these infants.  This study developed and validated a new quality measure, the aggregate complication measure (ACM), to evaluate hospitals according to the quality of care they provide after using direct standardization methods to control for differences in casemix. 

The Impact of Physiological Maturation of the Premature Infant on Perinatal Outcomes

Funded by the University of Pennsylvania McCabe Foundation
Principal Investigator:  Scott A. Lorch, MD, MSCE

The goals of this project were to determine the rate of physiological maturation of premature infants in those skills necessary for discharge to home (degree of respiratory support, control of breathing, coordination of feeding, ability to gain weight and control of core body temperature); (2) identify the relationship between the attainment of these skills and the short- and long-term outcome measures of 1-, 3- and 12-month readmission, total cost of medical care and use of emergency room services; and (3) validate a function maturity score to assist clinicians in optimizing the timing of discharge of premature infants.