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.


Related Articles

  • WHAT MAKES CANADA'S NICUS SO GOOD?  // Contemporary Pediatrics;Sep2009, Vol. 26 Issue 9, p16 

    The article focuses on a study of neonatal intensive care units (NICU) in Canada. It reveals that the country's NICU are reporting reduced incidence of bronchopulmonary dysplasia and nosocomial infections as a result of continuous quality improvement program. Findings suggest a moderate decline...

  • From gnosis to praxis. Weatherall, Mark // Australian & New Zealand Continence Journal;Winter2013, Vol. 19 Issue 2, p36 

    An introduction to the journal is presented in which the editor discusses various reports within the issue on topics including the importance of evidence-based medicine (EBM), concept of evidence-based practice (EBP), and limitations of EBM in randomised controlled trials (RCTs).

  • Whole Genome Sequence Typing to Investigate the Apophysomyces Outbreak following a Tornado in Joplin, Missouri, 2011. Etienne, Kizee A.; Gillece, John; Hilsabeck, Remy; Schupp, Jim M.; Colman, Rebecca; Lockhart, Shawn R.; Gade, Lalitha; Thompson, Elizabeth H.; Sutton, Deanna A.; Neblett-Fanfair, Robyn; Park, Benjamin J.; Turabelidze, George; Keim, Paul; Brandt, Mary E.; Deak, Eszter; Engelthaler, David M. // PLoS ONE;Nov2012, Vol. 7 Issue 11, Special section p1 

    Case reports of Apophysomyces spp. in immunocompetent hosts have been a result of traumatic deep implantation of Apophysomyces spp. spore-contaminated soil or debris. On May 22, 2011 a tornado occurred in Joplin, MO, leaving 13 tornado victims with Apophysomyces trapeziformis infections as a...

  • Antibiotic Use in Premature Infants After Discharge From the Neonatal Intensive Care Unit. Lorch, Scott A.; Wade, Kelly C.; Bakewell-Sachs, Susan; Medoff-Cooper, Barbara; Silber, Jeffrey H.; Escobar, Gabriel J. // Clinical Pediatrics;Apr2010, Vol. 49 Issue 3, p249 

    Using a retrospective cohort of premature infants, we constructed multivariable Poisson models to determine factors associated with the receipt of antibiotics during the first year after discharge, N = 891. Black race (incidence rate ratio 1.80 compared with White infants, P = .008), male gender...

  • PaCO2 in Surfactant, Positive Pressure, and Oxygenation Randomised Trial (SUPPORT). Ambalavanan, Namasivayam; Carlo, Waldemar A.; Wrage, Lisa A.; Das, Abhik; Laughon, Matthew; Cotten, C. Michael; Kennedy, Kathleen A.; Laptook, Abbot R.; Shankaran, Seetha; Walsh, Michele C.; Higgins, Rosemary D. // Archives of Disease in Childhood -- Fetal & Neonatal Edition;Mar2015, Vol. 100 Issue 2, pF145 

    Objective To determine the association of arterial partial pressure of carbon dioxide PaCO2 with severe intraventricular haemorrhage (sIVH), bronchopulmonary dysplasia (BPD), and neurodevelopmental impairment (NDI) at 18-22 months in premature infants. Design Secondary exploratory data analysis...

  • The good news-bad news about premature birth.  // Medical Update;Apr95, Vol. 18 Issue 10, p3 

    Reports on the proper medical care for premature infants. Advances made in the care for premature infants; Recommendation for specialized care in newborn intensive care units; Risks faced by premature infants when they reach school age.

  • Bridging the gaps: getting evidence into practice. McGuire, William; Fowlie, Peter W. // CMAJ: Canadian Medical Association Journal;10/13/2009, Vol. 181 Issue 8, p457 

    In this article the authors stress on the use of evidence-based therapy to cure diseases in premature infants. The authors mention that nosocomial infections and bronchopulmonary dysplasia are common diseases in premature children and refer to an evidence-based study suggesting the use of...

  • An evidence-based, multidisciplinary process for implementation of potentially better practices using a computerized medical record. Pantoja, Alfonso F.; Britton, John R. // International Journal for Quality in Health Care;Jun2011, Vol. 23 Issue 3, p309 

    Although the Institute of Medicine of the USA has recommended elements for healthcare reform, the optimal means for incorporation of these elements into a healthcare setting remain undefined. A process for the implementation of potentially better practices is described that incorporates a...

  • Association of a quality improvement program with neonatal outcomes in extremely preterm infants: a prospective cohort study. Shoo K. Lee; Shah, Prakesh S.; Singhal, Nalini; Aziz, Khalid; Synnes, Anne; McMillan, Douglas; Seshia, Mary M. // CMAJ: Canadian Medical Association Journal;9/16/2014, Vol. 186 Issue 13, p994 

    Background: We previously demonstrated improvement in bronchopulmonary dysplasia and nosocomial infection among preterm infants at 12 neonatal units using the Evidence-based Practice for Improving Quality (EPIQ). In the current study, we assessed the association of Canada-wide implementation of...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics