Collaborative Quality Improvement for Neonatal Intensive Care

Horbar, Jeffrey D.; Rogowski, Jeannette; Plsek, Paul E.; Delmore, Paula; Edwards, William H.; Hocker, James R.; Kantak, Anand; Lewallen, Patrick K.; Lewis, William H.; Lewit, Eugene M.; Mccarroll, Connie Jo; Mujsce, Dennis J.; Payne, Nathaniel R.; Shiono, Patricia H.; Soll, Roger F.; Leahy, Kathy; Carpenter, Joseph A.

doi:10.1542/peds.107.1.14

Cited by 345 publications

(104 citation statements)

References 8 publications

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“…Previous studies of the impact of collaboratives on organizational performance have mixed results, with some demonstrating substantial impact on improvement (Horbar et al 2001;Dellinger et al 2005;Howard et al 2007) and others finding no significant effect (Landon et al 2004;Homer et al 2005). The vast majority of these studies have examined collaboratives as a single intervention as opposed to the diverse set of features that comprise most collaborative models.…”

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confidence: 99%

Learning and Improving in Quality Improvement Collaboratives: Which Collaborative Features Do Participants Value Most?

Nembhard

2009

Health Services Research

123

137

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Objective. To understand participants' views on the relative helpfulness of various features of collaboratives, why each feature was helpful and which features the most successful participants viewed as most central to their success. Data Sources. Primary data collected from 53 teams in four [2004][2005] Institute for Healthcare Improvement (IHI) Breakthrough Series collaboratives; secondary data from IHI and demographic sources. Study Design. Cross-sectional analyses were conducted to assess participants' views of 12 features, and the relationship between their views and performance improvement. Data Collection Methods. Participants' views on features were obtained via selfadministered surveys and semi-structured telephone interviews. Performance improvement data were obtained from IHI and demographic data from secondary sources. Principal Findings. Participants viewed six features as most helpful for advancing their improvement efforts overall and knowledge acquisition in particular: collaborative faculty, solicitation of their staff's ideas, change package, Plan-Do-Study-Act cycles, Learning Session interactions, and collaborative extranet. These features also provided participants with motivation, social support, and project management skills. Features enabling interorganizational learning were rated higher by teams whose organizations improved significantly than by other teams. Conclusions. Findings identify features of collaborative design and implementation that participants view as most helpful and highlight the importance of interorganizational features, at least for those organizations that most improve.Key Words. Quality improvement collaboratives, organizational learning Quality improvement collaboratives are an increasingly common strategy for implementing evidence-based practices in health care. Most collaboratives are modeled after the Breakthrough Series (BTS) model, developed by the r Health Research and Educational Trust

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Learning and Improving in Quality Improvement Collaboratives: Which Collaborative Features Do Participants Value Most?

Nembhard

2009

Health Services Research

123

137

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“…No campo específico da qualidade da atenção neonatal, estratégias que possam garantir o acesso a práticas assistenciais adequadas e baseadas nas melhores evidências disponíveis são urgentes e prioritárias. Em vários países, as redes colaborativas neonatais têm se consolidado com o objetivo de melhorar a efetividade e eficiência da assistência neonatal através de programas coordenados de pesquisa, educação e projetos de melhoria da qualidade [36][37][38][39][40] . No Brasil, é grande a expectativa de que a Rede Brasileira de Pesquisas Neonatais (RBPN) possa colaborar ativamente na incorporação de práticas assistenciais adequadas e na melhoria da qualidade da atenção neonatal em todo o país 41 .…”

Section: Países Com Melhores Resultados Perinatais Brasilunclassified

Mortality of very low birth weight preterm infants in Brazil: reality and challenges

Carvalho¹,

Gomes²

2005

J Pediatr (Rio J)

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Como citar este artigo: de Carvalho M, Gomes MA. A mortalidade do prematuro extremo em nosso meio: realidade e desafios. J Pediatr (Rio J). 2005;81(1 Supl):S111-S118. AbstractObjective: The objective of this article is to review and discuss the medical literature on epidemiological indicators and organizational structure of the Brazilian perinatal health system concerning the care of very low birth weight premature infants (< 1,500 g).

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“…43 Highly functioning quality collaboratives at both the state and national levels provide a foundation for measurement and large-scale change. [44][45][46] Clinical care guidance and policy are centrally coordinated through the AAP committee structure (http://pediatrics.aappublications. org/site/aappolicy/index.xhtml).…”

Section: Discussionmentioning

confidence: 99%

Choosing Wisely in Newborn Medicine: Five Opportunities to Increase Value

et al. 2015

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BACKGROUND: The use of unnecessary tests and treatments contributes to health care waste. The “Choosing Wisely” campaign charges medical societies with identifying such items. This report describes the identification of 5 tests and treatments in newborn medicine. METHODS: A national survey identified candidate tests and treatments. An expert panel of 51 individuals representing 28 perinatal care organizations narrowed the list over 3 rounds of a modified Delphi process. In the final round, the panel was provided with Grading of Recommendation, Assessment, Development and Evaluation (GRADE) literature summaries of the top 12 tests and treatments. RESULTS: A total of 1648 candidate tests and 1222 treatments were suggested by 1047 survey respondents. After 3 Delphi rounds, the expert panel achieved consensus on the following top 5 items: (1) avoid routine use of antireflux medications for treatment of symptomatic gastroesophageal reflux disease or for treatment of apnea and desaturation in preterm infants, (2) avoid routine continuation of antibiotic therapy beyond 48 hours for initially asymptomatic infants without evidence of bacterial infection, (3) avoid routine use of pneumograms for predischarge assessment of ongoing and/or prolonged apnea of prematurity, (4) avoid routine daily chest radiographs without an indication for intubated infants, and (5) avoid routine screening term-equivalent or discharge brain MRIs in preterm infants. CONCLUSIONS: The Choosing Wisely Top Five for newborn medicine highlights tests and treatments that cannot be adequately justified on the basis of efficacy, safety, or cost. This list serves as a starting point for quality improvement efforts to optimize both clinical outcomes and resource utilization in newborn care.

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Collaborative Quality Improvement for Neonatal Intensive Care

Abstract: We conclude that multidisciplinary collaborative quality improvement has the potential to improve the outcomes of neonatal intensive care.

Cited by 345 publications

References 8 publications

Learning and Improving in Quality Improvement Collaboratives: Which Collaborative Features Do Participants Value Most?

Learning and Improving in Quality Improvement Collaboratives: Which Collaborative Features Do Participants Value Most?

Mortality of very low birth weight preterm infants in Brazil: reality and challenges

Choosing Wisely in Newborn Medicine: Five Opportunities to Increase Value

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