OBJECTIVE: We tested whether NICU teams trained in benchmarking and quality improvement would change practices and improve rates of survival without bronchopulmonary dysplasia in inborn neonates with birth weights of <1250 g. METHODS: A cluster-randomized trial enrolled 4093 inborn neonates with birth weights of <1250g at 17 centers of the National Institute of Child Health and Human Development Neonatal Research Network. Three centers were selected as best performers, and the remaining 14 centers were randomized to intervention or control. Changes in rates of survival free of bronchopulmonary dysplasia were compared between study year 1 and year 3. RESULTS: Intervention centers implemented potentially better practices successfully; changes included reduced oxygen saturation targets and reduced exposure to mechanical ventilation. Five of 7 intervention centers and 2 of 7 control centers implemented use of high-saturation alarms to reduce oxygen exposure. Lower oxygen saturation targets reduced oxygen levels in the first week of life. Despite these changes, rates of survival free of bronchopulmonary dysplasia were all similar between intervention and control groups and remained significantly less than the rate achieved in the best-performing centers (73.3%). CONCLUSIONS: In this cluster-randomized trial, benchmarking and multimodal quality improvement changed practices but did not reduce bronchopulmonary dysplasia rates.
RCT Entities:
OBJECTIVE: We tested whether NICU teams trained in benchmarking and quality improvement would change practices and improve rates of survival without bronchopulmonary dysplasia in inborn neonates with birth weights of <1250 g. METHODS: A cluster-randomized trial enrolled 4093 inborn neonates with birth weights of <1250 g at 17 centers of the National Institute of Child Health and Human Development Neonatal Research Network. Three centers were selected as best performers, and the remaining 14 centers were randomized to intervention or control. Changes in rates of survival free of bronchopulmonary dysplasia were compared between study year 1 and year 3. RESULTS: Intervention centers implemented potentially better practices successfully; changes included reduced oxygen saturation targets and reduced exposure to mechanical ventilation. Five of 7 intervention centers and 2 of 7 control centers implemented use of high-saturation alarms to reduce oxygen exposure. Lower oxygen saturation targets reduced oxygen levels in the first week of life. Despite these changes, rates of survival free of bronchopulmonary dysplasia were all similar between intervention and control groups and remained significantly less than the rate achieved in the best-performing centers (73.3%). CONCLUSIONS: In this cluster-randomized trial, benchmarking and multimodal quality improvement changed practices but did not reduce bronchopulmonary dysplasia rates.
Authors: P Brian Smith; Namasivayam Ambalavanan; Lei Li; C Michael Cotten; Matthew Laughon; Michele C Walsh; Abhik Das; Edward F Bell; Waldemar A Carlo; Barbara J Stoll; Seetha Shankaran; Abbot R Laptook; Rosemary D Higgins; Ronald N Goldberg Journal: Pediatrics Date: 2012-05-28 Impact factor: 7.124
Authors: Henry C Lee; Richard J Powers; Mihoko V Bennett; Neil N Finer; Louis P Halamek; Courtney Nisbet; Margaret Crockett; Kathy Chance; David Blackney; Connie von Köhler; Paul Kurtin; Paul J Sharek Journal: Pediatrics Date: 2014-10-20 Impact factor: 7.124
Authors: Rosemary D Higgins; Alan H Jobe; Marion Koso-Thomas; Eduardo Bancalari; Rose M Viscardi; Tina V Hartert; Rita M Ryan; Suhas G Kallapur; Robin H Steinhorn; Girija G Konduri; Stephanie D Davis; Bernard Thebaud; Ronald I Clyman; Joseph M Collaco; Camilia R Martin; Jason C Woods; Neil N Finer; Tonse N K Raju Journal: J Pediatr Date: 2018-03-16 Impact factor: 4.406