Baby-MONITOR: A Composite Indicator of NICU Quality

Profit, Jochen; Kowalkowski, Marc; Zupancic, John A.F.; Pietz, Kenneth; Richardson, Peter J.; Draper, David; Hysong, Sylvia J.; Thomas, Eric J.; Petersen, Laura A.; Gould, Jeffrey B.

doi:10.1542/peds.2013-3552

Cited by 69 publications

(79 citation statements)

References 27 publications

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“…40 Although the optimal nutritional strategy for preterm infants is unknown, the high rates of postnatal growth failure and the wide variation in rates among NICUs suggest that quality improvement efforts related to nutritional management may have a role to play in improving nutritional support and growth for preterm infants. Using a Delphi process and expert panel, Profit et al 41 identified GV as 1 of 9 key measures included in the Baby-MONITOR, a composite indicator of NICU quality. Several quality improvement collaboratives have focused their efforts on improving nutrition and growth.…”

Section: Discussionmentioning

confidence: 99%

Weight Growth Velocity and Postnatal Growth Failure in Infants 501 to 1500 Grams: 2000–2013

et al. 2015

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BACKGROUND: Very low birth weight infants often gain weight poorly and demonstrate growth failure during the initial hospitalization. Although many of the major morbidities experienced by these infants during their initial NICU stays have decreased in recent years, it is unclear whether growth has improved. METHODS: We studied 362 833 infants weighing 501 to 1500 g without major birth defects born from 2000 to 2013 and who were hospitalized for 15 to 175 days at 736 North American hospitals in the Vermont Oxford Network. Average growth velocity (GV; g/kg per day) was computed by using a 2-point exponential model on the basis of birth weight and discharge weight. Postnatal growth failure and severe postnatal growth failure were defined as a discharge weight less than the 10th and third percentiles for postmenstrual age, respectively. RESULTS: From 2000 to 2013, average GV increased from 11.8 to 12.9 g/kg per day. Postnatal growth failure decreased from 64.5% to 50.3% and severe postnatal growth failure from 39.8% to 27.5%. The interquartile ranges for the hospitals participating in 2013 were as follows: GV, 12.3 to 13.4 g/kg per day; postnatal growth failure, 41.1% to 61.7%; and severe postnatal growth failure, 19.4% to 36.0%. Adjusted and unadjusted estimates were nearly identical. CONCLUSIONS: For infants weighing 501 to 1500 g at birth, average GV increased and the percentage with postnatal growth failure decreased. However, in 2013, half of these infants still demonstrated postnatal growth failure and one-quarter demonstrated severe postnatal growth failure.

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Section: Discussionmentioning

confidence: 99%

Weight Growth Velocity and Postnatal Growth Failure in Infants 501 to 1500 Grams: 2000–2013

et al. 2015

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“…Computation of Baby-MONITOR scores requires that its sub-components are aligned according to valence (higher score = better performance), risk adjusted, and standardized using the Draper-Gittoes method (12, 21). With this method, a standardized observed minus expected z score was computed, with an expected mean of zero and a standard deviation of one.…”

Section: Methodsmentioning

confidence: 99%

“…Although individual measures contain important information, there is also value in summarizing performance by combining the information from multiple measures, because such a summary can convey quality from many different perspectives (10). In prior work, we created a composite indicator, the Baby-MONITOR, as a comprehensive measure of the care and outcomes for VLBW infants (11, 12). In this paper, we used the Baby-MONITOR and its individual components to examine whether care and outcomes differ between different NICU levels.…”

Section: Introductionmentioning

confidence: 99%

The Association of Level of Care With NICU Quality

et al. 2016

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Background and Objectives Regionalized care delivery purportedly optimizes care to vulnerable very low birth weight (VLBW; < 1500g) infants. However, a comprehensive assessment of quality of care delivery across different levels of Neonatal Intensive Care Units (NICUs) has not been done. Methods We conducted a cross-sectional analysis of 21,051 VLBW infants in 134 California NICUs. NICUs designated their level of care according to 2012 AAP guidelines. We assessed quality of care delivery via the Baby-MONITOR, a composite indicator, which combines nine risk-adjusted measures of quality. Baby-MONITOR scores are measured as observed minus expected performance, expressed in standard units with a mean of zero and a standard deviation of one. Results Wide variation in Baby-MONITOR scores exists across California (mean (SD) 0.18 (1.14), range -2.26 to 3.39). However, level of care was not associated with overall quality scores. Subcomponent analysis revealed trends for higher performance of Level IV NICUs on several process measures, including antenatal steroids and any human milk feeding at discharge, but lower scores for several outcomes including any health care associated infection, pneumothorax, and growth velocity. No other health system or organizational factors including hospital ownership, neonatologist coverage, urban or rural location, and hospital teaching status, were significantly associated with Baby-MONITOR scores. Conclusion The comprehensive assessment of the effect of level of care on quality reveals differential opportunities for improvement and allows monitoring of efforts to ensure that fragile VLBW infants receive care in appropriate facilities.

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“…For this purpose, we used the Baby-MONITOR composite indicator and its subcomponents (8). The Baby-MONITOR aggregates 9 risk-adjusted measures (2 process measures, 6 morbidities, and mortality) that span the birth hospitalization (9–11).…”

Section: Introductionmentioning

confidence: 99%

Racial/Ethnic Disparity in NICU Quality of Care Delivery

et al. 2017

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BACKGROUND Differences in neonatal intensive care unit (NICU) quality of care provided to very-low-birth-weight (VLBW; <1500g) infants may contribute to the persistence of racial/ethnic disparity. An examination of such disparities in a population-based sample across multiple dimensions of care and outcomes is lacking. METHODS Prospective observational analysis of 18,616 VLBW infants in 134 California NICUs between January 1, 2010 to December 31, 2014. We assessed quality of care delivery via the Baby-MONITOR, a composite indicator consisting of nine process and outcome measures of quality. For each NICU we calculated a risk adjusted composite and individual component quality score for each race/ethnicity. We standardized each score to the overall population to compare quality of care between and within NICUs. RESULTS We found clinically and statistically significant racial/ethnic variation in quality of care delivery between NICUs as well as within NICUs. Composite quality scores ranged by 5.26 standard units (range −2.30 to 2.96). Adjustment of Baby-MONITOR scores by race/ethnicity had only minimal effect on comparative assessments of NICU performance. Among subcomponents of the Baby-MONITOR, non-Hispanic White infants scored higher on measures of process compared with non-Hispanic Blacks and Hispanics. Compared with Whites, non-Hispanic Blacks scored higher on measures of outcome; Hispanics scored lower on seven of the nine Baby-MONITOR subcomponents. CONCLUSION Significant racial/ethnic variation in quality of care delivery exists between and within NICUs. Providing feedback of disparity scores to NICUs could serve as an important starting point for promoting improvement and reducing disparities.

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Baby-MONITOR: A Composite Indicator of NICU Quality

Cited by 69 publications

References 27 publications

Weight Growth Velocity and Postnatal Growth Failure in Infants 501 to 1500 Grams: 2000–2013

Weight Growth Velocity and Postnatal Growth Failure in Infants 501 to 1500 Grams: 2000–2013

The Association of Level of Care With NICU Quality

Racial/Ethnic Disparity in NICU Quality of Care Delivery

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