Sustained quality improvement in outcomes of preterm neonates with a gestational age less than 29 weeks: results from the Evidence-based Practice for Improving Quality Phase 3

Abstract

Quality improvement initiatives in neonatology have yielded positive results; however, few programs have demonstrated sustainability. We evaluated an ongoing, national quality improvement initiative (Evidence-based Practice for Improving Quality Phase 3 (EPIQ-3)) on outcomes of preterm neonates with a gestational age (GA) of 220–286 weeks (i.e., from 22 weeks and 0 days of gestation to 28 weeks and 6 days of gestation). Data from 7459 neonates admitted to 25 Canadian centers between 2013 and 2017 were studied. Trends in mortality and major morbidities were evaluated. The number of neonates with a GA of 220–236 weeks increased from 90 in 2013 to 139 in 2017 without a significant change in any other GA categories. In the entire cohort, the odds of composite outcome of mortality or any major morbidity (adjusted odds ratio (AOR) 0.72, 95% confidence interval (CI) 0.61–0.84) and of necrotizing enterocolitis (AOR 0.66, 95% CI 0.49–0.89) were lower in 2017 than in 2013. When calculated per year, the odds of composite outcome (AOR 0.93, 95% CI 0.89–0.97) and odds of necrotizing enterocolitis (AOR 0.89, 95% CI 0.82–0.96) decreased significantly. Among the subgroup of neonates with a GA of 260–286 weeks, the odds of composite outcome (AOR 0.63, 95% CI 0.51–0.79), necrotizing enterocolitis (AOR 0.44, 95% CI 0.26–0.73), and nosocomial infection (AOR 0.64, 95% CI 0.49–0.84) were reduced. The collaborative, multidisciplinary, nationwide EPIQ-3 program improved outcomes of preterm neonates, and the improvement was sustainable over 5 years.

Trends in Outcomes for Neonates Born Very Preterm and Very Low Birth Weight in 11 High-Income Countries

“…One major difference between Canada and the other countries in iNeo during the study period was a national program of continuous quality improvement. 14,15 In 2008, Canada implemented a national Evidencebased Practice for Improving Quality-2 initiative in 25 of 30 tertiary NICUs 14 that was continued as Evidence-based Practice for Improving Quality-3 between 2013 and 2017. 15 These programs were associated with a significant reduction in composite outcomes in Canada, and these improvements may be reflected in the current comparison.…”

The International Network for Evaluating Outcomes (iNeo) of neonates: evolution, progress and opportunities

“…(VI) Collaborative quality improvement activities: the greatest impact any data collection project can have is when data are converted to information and action. For example, multiple networks have reported successful neonatal outcome improvement through data-driven quality improvement efforts (62)(63)(64)(65)(66). However, many of the iNeo countries do not have established national/regional quality improvement programs that use their network data.…”

Net worth of networks: opportunities and potential

“…Quality improvement activities have been enabled by the formation of collaborative neonatal networks at regional, national and international levels. Such networks act as a conduit for benchmarking , trend evaluation , quality improvement , knowledge mobilisation, evaluative research, , and integrated comparative effectiveness research .…”

“…National networks could support outcome improvement by using the collected data to develop, support and implement quality improvement initiatives. The Austrian Preterm Outcome Study Network is part of a governmental quality assessment programme, which could facilitate quality improvement activities and achieve improved outcomes, reduce practice variability, and create opportunities for this to be a learning exercise for everyone involved .…”

“…The most important step after creating networks with comprehensive databases is to conduct collaborative quality improvement activities that help individual units to improve their outcomes. This can be done by learning from units with better outcomes or by developing joint efforts to target particular morbidities and reduce variability in evidence‐based treatments and in outcomes . For example, Kiechl‐Kohlendorfer et al.…”