Collaborative quality improvement for neonatal intensive care

Objective. To make measurable improvements in the quality and cost of neona tal intensive care using a multidisciplinary collaborative quality improvem ent model. Design. Interventional study. Patient demographic and clinical information for infants with birth weight 501 to 1500 g was collected using the Vermont Oxford Network Database for January 1, 1994 to December 31, 1997. Setting. Ten self-selected neonatal intensive care units (NICUs) received t he intervention. They formed 2 subgroups (6 NICUs working on infection, 4 N ICUs working on chronic lung disease). Sixty-six other NICUs served as a co ntemporaneous comparison group. Patients. Infants with birth weight 501 to 1500 g born at or admitted withi n 28 days of birth between 1994 and 1997 to the 6 study NICUs in the infect ion group (n = 3063) and the 66 comparison NICUs (n = 21 509); infants with birth weight 501 to 1000 g at the 4 study NICUs in the chronic lung diseas e group (n = 738). Interventions. NICUs formed multidisciplinary teams that worked together un der the direction of a trained facilitator over a 3-year period beginning i n January 1995. They received instruction in quality improvement, reviewed performance data, identified common improvement goals, and implemented "pot entially better practices" developed through analysis of the processes of c are, literature review, and site visits. Main Outcome Measures. The rates of infection after the third day of life w ith coagulase-negative staphylococcal or other bacterial pathogens for infa nts with birth weight 501 to 1500 g, and the rates of oxygen supplementatio n or death at 36 weeks' adjusted gestational age for infants with birth wei ght 501 to 1000 g. Results. Between 1994 and 1996, the rate of infection with coagulase-negati ve staphylococcus decreased from 22.0% to 16.6% at the 6 project NICUs in t he infection group; the rate of supplemental oxygen at 36 weeks' adjusted g estational age decreased from 43.5% to 31.5% at the 4 NICUs in the chronic lung disease group. There was heterogeneity in the effects among the NICUs in both project groups. The changes observed at the project NICUs for these outcomes were significantly larger than those observed at the 66 compariso n NICUs over the 4-year period from 1994 to 1997. Conclusion. We conclude that multidisciplinary collaborative quality improv ement has the potential to improve the outcomes of neonatal intensive care.