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


CONCLUSIONS
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.
Lee
Shoo K
SK
Departments of Paediatrics, University of Toronto, Toronto, Ontario, Canada. sklee@mtsinai.on.ca
Aziz
Khalid
K
Singhal
Nalini
N
Cronin
Catherine M
CM
James
Andrew
A
Lee
David S C
DS
Matthew
Derek
D
Ohlsson
Arne
A
Sankaran
Koravangattu
K
Seshia
Mary
M
Synnes
Anne
A
Walker
Robin
R
Whyte
Robin
R
Langley
Joanne
J
MacNab
Ying C
YC
Stevens
Bonnie
B
von Dadelszen
Peter
P
D001997:Bronchopulmonary Dysplasia / Q000453:epidemiology / Q000517:prevention & control*; D002170:Canada; D016000:Cluster Analysis; D003428:Cross Infection / Q000453:epidemiology / Q000628:therapy*; D019317:Evidence-Based Medicine / Q000379:methods* / Q000592:standards; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D007234:Infant, Premature; D007363:Intensive Care Units, Neonatal; D008297:Male; D011446:Prospective Studies; D011785:Quality Assurance, Health Care / Q000706:statistics & numerical data*