Baby-MONITOR: A Composite Indicator of NICU Quality

Abstract

WHAT'S KNOWN ON THIS SUBJECT:The traditional processfocused approach to quality improvement has not remedied NICUs' inconsistency in quality of care delivery across clinically important measures. Global measurement of quality may induce broad, systems-based improvement, but must be formally studied. WHAT THIS STUDY ADDS:We present a systematically developed and robust composite indicator, the Baby-MONITOR, to assess the quality of care delivered to very low birth weight infants in the NICU setting. abstract BACKGROUND AND OBJECTIVES: NICUs vary in the quality of care delivered to very low birth weight (VLBW) infants. NICU performance on 1 measure of quality only modestly predicts performance on others. Composite measurement of quality of care delivery may provide a more comprehensive assessment of quality. The objective of our study was to develop a robust composite indicator of quality of NICU care provided to VLBW infants that accurately discriminates performance among NICUs. METHODS:We developed a composite indicator, Baby-MONITOR, based on 9 measures of quality chosen by a panel of experts. Measures were standardized, equally weighted, and averaged. We used the California Perinatal Quality Care Collaborative database to perform acrosssectional analysis of care given to VLBW infants between 2004 and 2010. Performance on the Baby-MONITOR is not an absolute marker of quality but indicates overall performance relative to that of the other NICUs. We used sensitivity analyses to assess the robustness of the composite indicator, by varying assumptions and methods. RESULTS: Our sample included 9023 VLBW infants in 22 California regional NICUs. We found significant variations within and between NICUs on measured components of the Baby-MONITOR. Risk-adjusted composite scores discriminated performance among this sample of NICUs. Sensitivity analysis that included different approaches to normalization, weighting, and aggregation of individual measures showed the Baby-MONITOR to be robust (r = 0.89-0.99). CONCLUSIONS:The Baby-MONITOR may be a useful tool to comprehensively assess the quality of care delivered by NICUs. Pediatrics 2014;134:74-82