Continued improvement in morbidity reduction in extremely premature infants
| Autor: | Lian Wang, Eileen Steffen, Joseph W. Kaempf, Michael Dunn, Mindy Morris |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
Male
medicine.medical_specialty Quality management Gestational Age Infant Premature Diseases 03 medical and health sciences Child Development 0302 clinical medicine Intensive Care Units Neonatal 030225 pediatrics Intensive care Infant Mortality Humans Infant Very Low Birth Weight Medicine 030212 general & internal medicine Neonatology Intensive care medicine Intersectoral Collaboration Extremely premature business.industry Mortality rate Infant Newborn Infant Obstetrics and Gynecology Gestational age General Medicine Benchmarking Quality Improvement United States Outcome and Process Assessment Health Care Evidence-Based Practice Infant Extremely Premature Pediatrics Perinatology and Child Health Female Metric (unit) business |
| Zdroj: | Archives of Disease in Childhood - Fetal and Neonatal Edition. 106:265-270 |
| ISSN: | 1468-2052 1359-2998 |
| DOI: | 10.1136/archdischild-2020-319961 |
| Popis: | ObjectiveProvide a progress report updating our long-term quality improvement collaboration focused on major morbidity reduction in extremely premature infants 23–27 weeks.Methods10 Vermont Oxford Network (VON) neonatal intensive care units (NICUs) (the POD) sustained a structured alliance: (A) face-to-face meetings, site visits and teleconferences, (B) transparent process and outcomes sharing, (C) utilisation of evidence-based potentially better practice toolkits, (D) family integration and (E) benchmarking via a composite mortality–morbidity score (Benefit Metric). Morbidity-specific toolkits were employed variably by each NICU according to local priorities. The eight major VON morbidities and the risk-adjusted Benefit Metric were compared in two epochs 2010–2013 versus 2014–2018.Results5888 infants, mean (SD) gestational age 25.8 (1.4) weeks, were tracked. The POD Benefit Metric significantly improved (p=0.03) and remained superior to the aggregate VON both epochs (pConclusionsInter-NICU collaboration, process and outcomes sharing and potentially better practice toolkits sustain improvement in 23–27 week morbidity rates, notably chronic lung disease, extrauterine growth restriction and the lowest zero-or-one major morbidity rate reported by a quality improvement collaboration. Unrevealed biological and cultural variables affect morbidity rates, countless remain unmeasured, thus duplication to other quality improvement groups is challenging. Understanding intensive care as innumerable interactions and constant flux that defy convenient linear constructs is fundamental. |
| Databáze: | OpenAIRE |
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