Dd. Wirtschafter et al., PHYSICIAN PARTICIPATION IN QUALITY MANAGEMENT - USING HEALTH-CARE OUTCOMES TO IMPROVE PATIENT-CARE IN THE NICU, The Joint Commission journal on quality improvement, 20(2), 1994, pp. 57-65
Background: The Kaiser Permanente Medical Care Program, Southern Calif
ornia Region, implemented an outcomes-based research program within it
s neonatal intensive care units. Method. The primary objective of the
Kaiser outcomes monitoring project was to provide a mechanism for iden
tifying optimal care processes that can lead to reduced morbidity, mor
tality, and resource use in caring for infants, with low birth weights
. Comparisons with one benchmark study resulted in physician practice
pattern changes in the areas of discharge planning. For example, multi
disciplinary discharge-planning rounds were initiated, infants who wou
ld need home monitors or oxygen delivery devices were identified early
in the care continuum, and parents received timely training in infant
cardiopulmonary resuscitation. An analysis of nutritional practices w
ithin the Kaiser neonatal intensive care units (NICUs) resulted in the
reduction of nosocomial infection rates and improvements in infant we
ight gains. Modification of ventilation practices reduced a high rate
of severe intracranial hemorrhage in another NICU. Analysis is ongoing
on the causes of lengthier durations of ventilation at one Kaiser NIC
U.Conclusion: A recent survey of NICUs revealed that 80% of respondent
s were capable of performing their own outcomes research. The authors
suggest that a national organization be formed to assist NICUs in the
abstracting, collecting, and comparing of NICU data to study areas of
interest.