title: A cluster-randomized trial of benchmarking and multimodal quality improvement to improve rates of survival free of bronchopulmonary dysplasia for infants with birth weights of less than 1250 grams.
abstract: 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.affiliation: Department of Pediatrics, Rainbow Babies & Children's Hospital, Case Western Reserve University, Cleveland, Ohio 44106-6010, USA. michele.walsh@cwru.edu
authors.forename: Michele
authors.initials: M
authors.lastname: Walsh
authors.forename: Abbott
authors.initials: A
authors.lastname: Laptook
authors.forename: S Nadya
authors.initials: SN
authors.lastname: Kazzi
authors.forename: William A
authors.initials: WA
authors.lastname: Engle
authors.forename: Qing
authors.initials: Q
authors.lastname: Yao
authors.forename: Maynard
authors.initials: M
authors.lastname: Rasmussen
authors.forename: Susie
authors.initials: S
authors.lastname: Buchter
authors.forename: Gregory
authors.initials: G
authors.lastname: Heldt
authors.forename: William
authors.initials: W
authors.lastname: Rhine
authors.forename: Rose
authors.initials: R
authors.lastname: Higgins
authors.forename: Kenneth
authors.initials: K
authors.lastname: Poole
mesh_terms: D000328:Adult; D019985:Benchmarking / Q000379:methods*; D001997:Bronchopulmonary Dysplasia / Q000401:mortality* / Q000628:therapy*; D016000:Cluster Analysis; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight; D008297:Male; D011247:Pregnancy; D015996:Survival Rate / Q000639:trends