title: Evaluation and development of potentially better practices to prevent chronic lung disease and reduce lung injury in neonates.
abstract: OBJECTIVE
  Despite increased knowledge and improving technology, chronic lung disease (CLD) rates in extremely low birth weight infants have remained constant for 20 years. One reason for this is an ineffective translation of research-proven improvements into practice. The Neonatal Intensive Care Quality Improvement Collaborative Year 2000 (NIC/Q 2000) was created to provide participating nurseries the tools necessary to effect change. The objective of this study was to develop and implement a process that uses quality improvement techniques to collaboratively improve CLD rates.
  
  
  METHODS
  Nine member hospitals of the NIC/Q 2000 collaborative formed a focus group aiming to decrease CLD rates. The focus group established goals and outcome measures, created a list of potentially better practices (PBPs) based on available literature, benchmarked and performed site visits, encouraged individual site implementation of PBPs, developed a database, and measured outcomes.
  
  
  RESULTS
  The goal "decrease CLD rates in extremely low birth weight infants" was established. Nine PBPs were identified, and 57 PBPs were implemented by the 9 participating sites. Twelve site visits were conducted, and a 435-patient database of infants with a mean birth weight of 789 g was established.
  
  
  CONCLUSIONS
  Collaborative use of quality improvement techniques resulted in creation of a logical, efficient, and effective process to improve CLD rates. Group creation of PBPs, based on literature review and reinforced with site visits, internal data analysis, and improved individual site outcomes, resulted in accelerated and effective change, unlikely to occur if attempted outside of the collaborative.
authors.affiliation: Lucile Packard Children's Hospital, Stanford University School of Medicine, Palo Alto, California, USA. psharek@stanford.edu
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Sharek
authors.forename: Robin
authors.initials: R
authors.lastname: Baker
authors.forename: Fern
authors.initials: F
authors.lastname: Litman
authors.forename: Joseph
authors.initials: J
authors.lastname: Kaempf
authors.forename: Kelly
authors.initials: K
authors.lastname: Burch
authors.forename: Edward
authors.initials: E
authors.lastname: Schwarz
authors.forename: Shyan
authors.initials: S
authors.lastname: Sun
authors.forename: Nathaniel R
authors.initials: NR
authors.lastname: Payne
mesh_terms: D019985:Benchmarking; D002908:Chronic Disease; D003299:Cooperative Behavior; D019317:Evidence-Based Medicine; D017144:Focus Groups; D006801:Humans; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight; D007363:Intensive Care Units, Neonatal / Q000458:organization & administration / Q000592:standards*; D015931:Intensive Care, Neonatal / Q000379:methods* / Q000592:standards; D008171:Lung Diseases / Q000517:prevention & control*; D009936:Organizational Innovation; D009937:Organizational Objectives; D010043:Outcome and Process Assessment, Health Care; D017749:Total Quality Management / Q000379:methods*; D014481:United States