Background An equitable and affordable healthcare system requires a constant search for the optimal way to deliver increasingly expensive neonatal care. Therefore, evaluating the impact of hospital intensity around birth on long-term health outcomes is necessary if we are to assess the value of high intensity neonatal care against its costs. Methods This study exploits uneven geographical distribution of high intensity birth hospitals across Canada to generate comparisons across similar Cerebral Palsy (CP) related births treated at hospitals with different intensities. We employ a rich dataset from the Canadian Multi-Regional CP Registry (CCPR) and instrumental variables related to the mother’s location of residence around birth. Results We find that differences in hospitals’ intensities are not associated with differences in clinically relevant, long-term CP health outcomes. Conclusions Our results suggest that existing matching mechanism of births to hospitals within large metropolitan areas could be improved by early detection of high risk births and subsequent referral of these births to high intensity birthing centers. Substantial hospitalization costs might be averted to Canadian healthcare system ($16 million with a 95% CI of $6,131,184 - $24,103,478) if CP related births were assigned to low intensity hospitals and subsequently transferred if necessary to high intensity hospitals.

中文翻译：

---

出生前后高强度护理对长期神经发育结果的影响。

背景 公平且负担得起的医疗保健系统需要不断寻找最佳方式来提供日益昂贵的新生儿护理。因此，如果我们要根据其成本评估高强度新生儿护理的价值，则有必要评估出生前后医院强度对长期健康结果的影响。方法 本研究利用加拿大各地高强度分娩医院的不均匀地理分布，对在不同强度的医院治疗的类似脑瘫 (CP) 相关分娩进行比较。我们采用了加拿大多区域 CP 登记处 (CCPR) 的丰富数据集以及与母亲出生前后居住地相关的工具变量。结果 我们发现医院强度的差异与临床相关的长期 CP 健康结果的差异无关。结论 我们的研究结果表明，通过及早发现高危新生儿并随后将这些新生儿转诊至高强度分娩中心，可以改善大城市地区现有的分娩匹配机制。如果将脑瘫相关的新生儿分配到低强度医院，然后在必要时转移到高强度医院，加拿大医疗保健系统可能会避免大量住院费用（1600万美元，95%置信区间为6,131,184美元 - 24,103,478美元）。