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

Shoo K. Lee; Khalid Aziz; Nalini Singhal; Catherine M. Cronin; Andrew James; David S.C. Lee; Derek Matthew; Arne Ohlsson; Koravangattu Sankaran; Mary Seshia; Anne Synnes; Robin Walker; Robin Whyte; Joanne Langley; Ying C. MacNab; Bonnie Stevens; Peter Von Dadelszen

doi:10.1503/cmaj.081727

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

Shoo K. Lee, Khalid Aziz, Nalini Singhal, Catherine M. Cronin, Andrew James, David S.C. Lee, Derek Matthew, Arne Ohlsson, Koravangattu Sankaran, Mary Seshia, Anne Synnes, Robin Walker, Robin Whyte, Joanne Langley, Ying C. MacNab, Bonnie Stevens, Peter Von Dadelszen

Medicine

Research output: Contribution to journal › Article › peer-review

107 Citations (Scopus)

Abstract

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.

Original language	English
Pages (from-to)	469-476
Number of pages	8
Journal	CMAJ
Volume	181
Issue number	8
DOIs	https://doi.org/10.1503/cmaj.081727
Publication status	Published - 2009

Bibliographical note

Funding Information:
Funding: This study was supported by grant MOP-53115 from the Canadian Institutes of Health Research . Additional funding was provided by BC's Children's Hospital Foundation; Calgary Regional Health Authority; Dal-housie University Neonatal-Perinatal Research Fund; Division of Neonatology, Children's Hospital of Eastern Ontario; Child Health Program, Health Care Corporation of St John's; Janeway Hospital Foundation; Newfoundland and Labrador Centre for Applied Health Research; The Neonatology Program, Hospital for Sick Children; Lawson Research Institute; Mount Sinai Hospital; Ontario Ministry of Health and Long-Term Care; Saint Boniface Hospital, Saint Joseph's Health Centre; University of Saskatchewan Neonatal Research Fund; University of Western Ontario; Victoria General Hospital; and the Winnipeg Health Sciences Centre.

ASJC Scopus Subject Areas

General Medicine

PubMed: MeSH publication types

Clinical Trial, Phase I
Clinical Trial, Phase II
Comparative Study
Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

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Cite this

Lee, S. K., Aziz, K., Singhal, N., Cronin, C. M., James, A., Lee, D. S. C., Matthew, D., Ohlsson, A., Sankaran, K., Seshia, M., Synnes, A., Walker, R., Whyte, R., Langley, J., MacNab, Y. C., Stevens, B., & Von Dadelszen, P. (2009). Improving the quality of care for infants: A cluster randomized controlled trial. CMAJ, 181(8), 469-476. https://doi.org/10.1503/cmaj.081727

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abstract = "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.",

author = "Lee, {Shoo K.} and Khalid Aziz and Nalini Singhal and Cronin, {Catherine M.} and Andrew James and Lee, {David S.C.} and Derek Matthew and Arne Ohlsson and Koravangattu Sankaran and Mary Seshia and Anne Synnes and Robin Walker and Robin Whyte and Joanne Langley and MacNab, {Ying C.} and Bonnie Stevens and {Von Dadelszen}, Peter",

note = "Funding Information: Funding: This study was supported by grant MOP-53115 from the Canadian Institutes of Health Research . Additional funding was provided by BC's Children's Hospital Foundation; Calgary Regional Health Authority; Dal-housie University Neonatal-Perinatal Research Fund; Division of Neonatology, Children's Hospital of Eastern Ontario; Child Health Program, Health Care Corporation of St John's; Janeway Hospital Foundation; Newfoundland and Labrador Centre for Applied Health Research; The Neonatology Program, Hospital for Sick Children; Lawson Research Institute; Mount Sinai Hospital; Ontario Ministry of Health and Long-Term Care; Saint Boniface Hospital, Saint Joseph's Health Centre; University of Saskatchewan Neonatal Research Fund; University of Western Ontario; Victoria General Hospital; and the Winnipeg Health Sciences Centre. ",

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doi = "10.1503/cmaj.081727",

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AU - Lee, Shoo K.

AU - Aziz, Khalid

AU - Singhal, Nalini

AU - Cronin, Catherine M.

AU - James, Andrew

AU - Lee, David S.C.

AU - Matthew, Derek

AU - Ohlsson, Arne

AU - Sankaran, Koravangattu

AU - Seshia, Mary

AU - Synnes, Anne

AU - Walker, Robin

AU - Whyte, Robin

AU - Langley, Joanne

AU - MacNab, Ying C.

AU - Stevens, Bonnie

AU - Von Dadelszen, Peter

N1 - Funding Information: Funding: This study was supported by grant MOP-53115 from the Canadian Institutes of Health Research . Additional funding was provided by BC's Children's Hospital Foundation; Calgary Regional Health Authority; Dal-housie University Neonatal-Perinatal Research Fund; Division of Neonatology, Children's Hospital of Eastern Ontario; Child Health Program, Health Care Corporation of St John's; Janeway Hospital Foundation; Newfoundland and Labrador Centre for Applied Health Research; The Neonatology Program, Hospital for Sick Children; Lawson Research Institute; Mount Sinai Hospital; Ontario Ministry of Health and Long-Term Care; Saint Boniface Hospital, Saint Joseph's Health Centre; University of Saskatchewan Neonatal Research Fund; University of Western Ontario; Victoria General Hospital; and the Winnipeg Health Sciences Centre.

PY - 2009

Y1 - 2009

N2 - 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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Improving the quality of care for infants: A cluster randomized controlled trial

Abstract

Bibliographical note

ASJC Scopus Subject Areas

PubMed: MeSH publication types

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