IDENTIFICATION OF NEONATAL DEATHS IN A LARGE MANAGED CARE ORGANIZATION

The neonatal (<28 days) mortality rate (NMR) is one of the most common ly employed maternal and child health epidemiological measures. It is also being employed in quality measures ('report cards') used to asses s the performance of health care organisations. The objectives were to (1) develop methods for the rapid quantification of the neonatal mort ality rate in a multi-hospital system, the Kaiser Permanente Medical C are Program's Northern California Region (KPMCP NCR), (2) develop meth ods for generating facility-specific rates and case lists, and (3) asc ertain the capture rates of the information sources available to us. P otential neonatal deaths were identified in the KPMCP NCR for the 1990 and 1991 calendar years from 3 sources: (1) clerical searches of loca l facility records, (2) electronic searches of the KPMCP NCR hospitali sation database, and (3) linking KPMCP electronic birth records to dea th certificate tapes. The medical records of all infants identified th rough these methods were reviewed. The neonatal mortality rate was cal culated in three ways: (1) including all livebirths, (2) excluding bir ths weighing <500g, and (3) adjusting for prematurity by increasing th e follow-up period in preterm babies (these babies were included as ne onatal deaths if they died up to 40 weeks corrected age +27.9 days). A total of 352 records out of 64469 birth records in the KPMCP NCR were reviewed. If one includes babies <500 g, the neonatal mortality rate was 3.72/1000 livebirths; if these babies are excluded, the rate was 3 .05/1000. Adjusting for prematurity increased these rates to 3.91/1000 and 3.24/1000, respectively. Accurate quantification of the neonatal mortality rate in a multihospital system requires the use of multiple information sources. Use of a single source can lead to varying rates of over- or under-estimation. It is possible to employ our methodology for both research and operational purposes.