Modelling the neonatal system: A joint analysis of length of stay and patient pathways

© 2019 John Wiley & Sons, Ltd. This is the peer reviewed version of the following article: Modelling the neonatal system: A joint analysis of length of stay and patient pathways, which has been published on 27/11/2019 in final form at https://doi.org/10.1002/hpm.2928. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions.In the United Kingdom, one in seven babies require specialist neonatal care after birth, with a noticeable increase in demand. Coupled with budgeting constraints and lack of investment means that neonatal units are struggling. This will inevitably have an impact on baby's length of stay (LoS) and the performance of the service. Models have previously been developed to capture individual babies' pathways to investigate the longitudinal cycle of care. However, no models have been developed to examine the joint analysis of LoS and babies' pathways. LoS at each stage of care is a critical driver of both the clinical outcomes and economic performance of the neonatal system. Using the generalized linear mixed modelling approach, extended to accommodate multiple outcomes, the association between neonate's pathway to discharge and LoS is examined. Using the data about 1002 neonates, we noticed that there is a high positive association between baby's pathway and total LoS, suggesting that discharge policies needs to be looked at more carefully. A novel statistical approach that examined the association of key outcomes and how it evolved over time is developed. Its applicability can be extended to other types of long-term care or diseases, such as heart failure and stroke.Peer reviewedFinal Accepted Versio

Nonproportional random effects modelling of a neonatal unit operational patient pathways

Special care, High dependency, Intensive care, Birth weight, Gestation age, Patient pathways, Frailty, Neonatal care,