title: Baby-MONITOR: a composite indicator of NICU quality.
abstract: OBJECTIVE
  NICUs vary in the quality of care delivered to very low birth weight (VLBW) infants. NICU performance on 1 measure of quality only modestly predicts performance on others. Composite measurement of quality of care delivery may provide a more comprehensive assessment of quality. The objective of our study was to develop a robust composite indicator of quality of NICU care provided to VLBW infants that accurately discriminates performance among NICUs.
  
  
  METHODS
  We developed a composite indicator, Baby-MONITOR, based on 9 measures of quality chosen by a panel of experts. Measures were standardized, equally weighted, and averaged. We used the California Perinatal Quality Care Collaborative database to perform across-sectional analysis of care given to VLBW infants between 2004 and 2010. Performance on the Baby-MONITOR is not an absolute marker of quality but indicates overall performance relative to that of the other NICUs. We used sensitivity analyses to assess the robustness of the composite indicator, by varying assumptions and methods.
  
  
  RESULTS
  Our sample included 9023 VLBW infants in 22 California regional NICUs. We found significant variations within and between NICUs on measured components of the Baby-MONITOR. Risk-adjusted composite scores discriminated performance among this sample of NICUs. Sensitivity analysis that included different approaches to normalization, weighting, and aggregation of individual measures showed the Baby-MONITOR to be robust (r = 0.89-0.99).
  
  
  CONCLUSIONS
  The Baby-MONITOR may be a useful tool to comprehensively assess the quality of care delivered by NICUs.
authors.affiliation: Perinatal Epidemiology and Health Outcomes Research Unit, Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children's Hospital; Palo Alto, California;California Perinatal Quality Care Collaborative; Palo Alto, California; profit@stanford.edu.
authors.forename: Jochen
authors.initials: J
authors.lastname: Profit
authors.affiliation: Levine Cancer Institute, Carolinas HealthCare System, Charlotte, North Carolina;
authors.forename: Marc A
authors.initials: MA
authors.lastname: Kowalkowski
authors.affiliation: Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts;Division of Newborn Medicine, Harvard Medical School, Boston, Massachusetts;
authors.forename: John A F
authors.initials: JA
authors.lastname: Zupancic
authors.affiliation: Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, Texas;Houston Veterans Affairs (VA) Health Services Research and Development Center of Excellence, Health Policy and Quality Program, Michael E. DeBakey VA Medical Center; Houston, Texas;
authors.forename: Kenneth
authors.initials: K
authors.lastname: Pietz
authors.affiliation: Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, Texas;Houston Veterans Affairs (VA) Health Services Research and Development Center of Excellence, Health Policy and Quality Program, Michael E. DeBakey VA Medical Center; Houston, Texas;
authors.forename: Peter
authors.initials: P
authors.lastname: Richardson
authors.affiliation: Department of Applied Mathematics and Statistics, Baskin School of Engineering, University of California, Santa Cruz, California;eBay Research Labs, San Jose, California;
authors.forename: David
authors.initials: D
authors.lastname: Draper
authors.affiliation: Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts;Division of Newborn Medicine, Harvard Medical School, Boston, Massachusetts;
authors.forename: Sylvia J
authors.initials: SJ
authors.lastname: Hysong
authors.affiliation: University of Texas at Houston - Memorial Hermann Center for Healthcare Quality and Safety, University of Texas Medical School, Houston, Texas.
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Thomas
authors.affiliation: Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts;Division of Newborn Medicine, Harvard Medical School, Boston, Massachusetts;
authors.forename: Laura A
authors.initials: LA
authors.lastname: Petersen
authors.affiliation: Perinatal Epidemiology and Health Outcomes Research Unit, Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children's Hospital; Palo Alto, California;California Perinatal Quality Care Collaborative; Palo Alto, California;
authors.forename: Jeffrey B
authors.initials: JB
authors.lastname: Gould
mesh_terms: D005260:Female; D006801:Humans; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight; D007363:Intensive Care Units, Neonatal / Q000592:standards*; D015931:Intensive Care, Neonatal / Q000592:standards*; D008297:Male; D019984:Quality Indicators, Health Care
keywords: infant; newborn; performance measurement; quality of care