Improving the quality of care for infants: a cluster randomized controlled trial

Lee, Shoo K.; Aziz, Khalid; Singhal, Nalini; Cronin, Catherine M.; James, Andrew; Lee, David S. C.; Matthew, Derek; Ohlsson, Arne; Sankaran, Koravangattu; Seshia, Mary; Synnes, Anne; Walker, Robin; Whyte, Robin; Langley, Joanne; MacNab, Ying C.; Stevens, Bonnie; von Dadelszen, Peter
October 2009
CMAJ: Canadian Medical Association Journal;10/13/2009, Vol. 181 Issue 8, p469
Academic Journal
Background: We developed and tested a new method, called the Evidence-based Practice for Improving Quality method, for continuous quality improvement. Methods: We used cluster randomization to assign 6 neonatal intensive care units (ICUs) to reduce nosocomial infection (infection group) and 6 ICUs to reduce bronchopulmonary dysplasia (pulmonary group). We included all infants born at 32 or fewer weeks gestation. We collected baseline data for 1 year. Practice change interventions were implemented using rapid-change cycles for 2 years. Results: The difference in incidence trends (slopes of trend lines) between the ICUs in the infection and pulmonary groups was -0.0020 (95% confidence interval [CI] -0.0007 to 0.0004) for nosocomial infection and -0.0006 (95% CI -0.0011 to -0.0001) for bronchopulmonary dysplasia. Interpretation: The results suggest that the Evidence-based Practice for Improving Quality method reduced bronchopulmonary dysplasia in the neonatal ICU and that it may reduce nosocomial infection.


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