title: Implementation methods for delivery room management: a quality improvement comparison study.
abstract: BACKGROUND
  There is little evidence to compare the effectiveness of large collaborative quality improvement versus individual local projects.
  
  
  METHODS
  This was a prospective pre-post intervention study of neonatal resuscitation practice, comparing 3 groups of nonrandomized hospitals in the California Perinatal Quality Care Collaborative: (1) collaborative, hospitals working together through face-to-face meetings, webcasts, electronic mailing list, and data sharing; (2) individual, hospitals working independently; and (3) nonparticipant hospitals. The collaborative and individual arms participated in improvement activities, focusing on reducing hypothermia and invasive ventilatory support.
  
  
  RESULTS
  There were 20 collaborative, 31 individual, and 44 nonparticipant hospitals caring for 12,528 eligible infants. Each group had reduced hypothermia from baseline to postintervention. The collaborative group had the most significant decrease in hypothermia, from 39% to 21%, compared with individual hospital efforts of 38% to 33%, and nonparticipants of 42% to 34%. After risk adjustment, the collaborative group had twice the magnitude of decrease in rates of newborns with hypothermia compared with the other groups. Collaborative improvement also led to greater decreases in delivery room intubation (53% to 40%) and surfactant administration (37% to 20%).
  
  
  CONCLUSIONS
  Collaborative efforts resulted in larger improvements in delivery room outcomes and processes than individual efforts or nonparticipation. These findings have implications for planning quality improvement projects for implementation of evidence-based practices.
authors.affiliation: Divisions of Neonatal & Developmental Medicine and California Perinatal Quality Care Collaborative, Palo Alto, California; hclee@stanford.edu.
authors.forename: Henry C
authors.initials: HC
authors.lastname: Lee
authors.affiliation: Division of Neonatology, Department of Pediatrics, Good Samaritan Hospital, San Jose, California;
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Powers
authors.affiliation: Divisions of Neonatal & Developmental Medicine and California Perinatal Quality Care Collaborative, Palo Alto, California;
authors.forename: Mihoko V
authors.initials: MV
authors.lastname: Bennett
authors.affiliation: Division of Neonatology, Department of Pediatrics, University of California San Diego, San Diego, California;
authors.forename: Neil N
authors.initials: NN
authors.lastname: Finer
authors.affiliation: Divisions of Neonatal & Developmental Medicine and.
authors.forename: Louis P
authors.initials: LP
authors.lastname: Halamek
authors.affiliation: Divisions of Neonatal & Developmental Medicine and California Perinatal Quality Care Collaborative, Palo Alto, California;
authors.forename: Courtney
authors.initials: C
authors.lastname: Nisbet
authors.affiliation: Sutter Medical Center, Sacramento, California;
authors.forename: Margaret
authors.initials: M
authors.lastname: Crockett
authors.affiliation: California Children's Services, Sacramento, California;
authors.forename: Kathy
authors.initials: K
authors.lastname: Chance
authors.affiliation: Sutter Medical Center, Sacramento, California;
authors.forename: David
authors.initials: D
authors.lastname: Blackney
authors.affiliation: Miller Children's Hospital Long Beach, MemorialCare Health System, Long Beach, California;
authors.forename: Connie
authors.initials: C
authors.lastname: von Köhler
authors.affiliation: Rady Children's Hospital, San Diego, California; and.
authors.forename: Paul
authors.initials: P
authors.lastname: Kurtin
authors.affiliation: California Perinatal Quality Care Collaborative, Palo Alto, California; General Pediatrics, Department of Pediatrics, Stanford University, Palo Alto, California; Center for Quality and Clinical Effectiveness, Lucile Packard Children's Hospital, Palo Alto, California.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Sharek
mesh_terms: D000328:Adult; D015331:Cohort Studies; D003696:Delivery Rooms / Q000592:standards* / Q000639:trends; D036861:Delivery, Obstetric / Q000379:methods / Q000592:standards* / Q000639:trends; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008137:Longitudinal Studies; D008297:Male; D011247:Pregnancy; D011446:Prospective Studies; D058996:Quality Improvement / Q000592:standards* / Q000639:trends
keywords: collaborative; neonatal resuscitation; quality improvement; very low birth weight