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Sivadanam S, Teiko-Awere E, Tumin D, Haberstroh A, Reis H, Akpan US. Scholarly Impact of Quality Improvement Reports in Neonatology. Am J Perinatol 2024. [PMID: 38857623 DOI: 10.1055/s-0044-1787544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/12/2024]
Abstract
OBJECTIVE Neonatology quality improvement (QI) projects can improve the safety and value of health care, but the scholarly impact of published QI projects is unclear. We measured scholarly citation and media attention garnered by published neonatology QI projects and analyzed project or publication characteristics associated with increased impact metrics. STUDY DESIGN We identified publications between 2016 and 2019 using mapping review methodology. We correlated project characteristics with measures of scholarly citation in Scopus and Google Scholar, and media attention as measured by Altmetrics. We collected Citation and Altmetric data in 2023. RESULTS The search identified 148 eligible articles, with a median citation count of 7 based on Scopus (or 12, based on Google Scholar) and a median Altmetric score of 2. Notably, 66% of articles published in a journal with an Impact Factor (IF) had more citations per year than would be expected from the IF value. Higher scientific citations were associated with articles reporting process and cost outcomes; implementing interventions that addressed family education or organizational change; and using regression analysis. Higher media attention was associated with multicenter projects, longer intervention periods, and projects scoring higher on the Quality Improvement Minimum Quality Criteria Set (QI-MQCS) rubric. CONCLUSION Published neonatology QI projects are well cited in subsequent scientific publications, with the choice of project outcome, interventions, and analytic strategy influencing citation metrics. Adherence to QI-MQCS guidelines was favorably associated with media attention, but not with scholarly citations. KEY POINTS · Neonatology QI publications are frequently cited.. · Projects with cost data receive more citations.. · Citation and media mention predictors differ..
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Affiliation(s)
- Supriya Sivadanam
- Brody School of Medicine at East Carolina University, Greenville, North Carolina
| | - Edna Teiko-Awere
- Brody School of Medicine at East Carolina University, Greenville, North Carolina
| | - Dmitry Tumin
- Department of Academic Affairs, Brody School of Medicine at East Carolina University, Greenville, North Carolina
| | - Amanda Haberstroh
- Laupus Library, East Carolina University, Greenville, North Carolina
| | - Heidi Reis
- Laupus Library, East Carolina University, Greenville, North Carolina
| | - Uduak S Akpan
- Department of Pediatrics, Brody School of Medicine at East Carolina University, Greenville, North Carolina
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Williamson SL, Singh N. NEO-TRAIN pushing the boundaries of quality improvement on the neonatal unit. Arch Dis Child Educ Pract Ed 2023; 108:374-376. [PMID: 36918254 DOI: 10.1136/archdischild-2022-325060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 02/19/2023] [Indexed: 03/16/2023]
Affiliation(s)
| | - Nitesh Singh
- Neonatal Unit, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
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Hu ZJ, Fusch G, Hu C, Wang JY, Munroe M, el Helou S, Thabane L. Methodologic attributes of quality improvement studies in neonatology: a systematic survey. BMJ Open Qual 2022. [PMCID: PMC9445793 DOI: 10.1136/bmjoq-2022-001898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Introduction Quality improvement (QI) is a growing field of inquiry in healthcare, including neonatology. However, there is limited information on the study setting, and the methodologic approaches used to develop, implement and evaluate QI interventions in neonatology studies. In this study, we describe these intervention characteristics and approaches. Methods Articles were taken from a previous publication. There, we searched MEDLINE for publications of QI studies from 2016 to 16 April 2020. We retrieved all relevant full-text publications and sampled 100 of these articles for data abstraction, stratified by the year of publication. For each QI study, we described several methodological characteristics that included: the clinical topic of QI, setting, whether the study was multicentre, stakeholder engagement, root cause analysis and related problem identification methods, implementation techniques for QI interventions, types of outcomes and statistical analysis methods used. Results We assessed 100 studies; most were conducted in the USA (56%). Academic settings and multicentre settings comprised 44% and 24% of studies, respectively. Most studies reported stakeholder engagement (81%), but infrequently reported engagement with leadership (32%) and caregivers (10%). Frequently used techniques for implementing interventions include provider education (82%), formal QI methods (42%) and audit, feedback and benchmarking (40%). Both patient-important clinical outcomes (78%) and process outcomes (89%) were frequently reported. P values were frequently reported (80%), but other statistical techniques were infrequently used. Conclusion QI studies in neonatology use diverse multicomponent interventions. Reporting of these methodologic details can be useful in designing, implementing and evaluating QI studies in clinical practice.
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Affiliation(s)
- Zheng Jing Hu
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Gerhard Fusch
- Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Catherine Hu
- Bachelor of Arts and Science, McMaster University, Hamilton, Ontario, Canada
| | - Jie Yi Wang
- Bachelor of Medical Sciences, University of Western Ontario, North York, Ontario, Canada
| | - Maleeka Munroe
- Global Health, McMaster University, Hamilton, Ontario, Canada
| | - Salhab el Helou
- Department of Health Research Methods, Evidence and Impact, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence and Impact, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
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What's New in Practice Improvements in Neonatal Care? Adv Neonatal Care 2022; 22:281-282. [PMID: 35901466 DOI: 10.1097/anc.0000000000001025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Obaid M, Igawa T, Maxwell A, Murray YL, Rahman A, Aboudi D, Olivo K, Roeder T, Valdes-Greene R, Brumberg H, Alpan G, Parvez B. "Liquid Gold" Lactation Bundle and Breastfeeding Rates in Racially Diverse Mothers of Extremely Low-Birth-Weight Infants. Breastfeed Med 2021; 16:463-470. [PMID: 34042464 DOI: 10.1089/bfm.2020.0322] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background: In 2015, we implemented a comprehensive lactation bundle named Liquid Gold. Lactation bundles in the neonatal intensive care unit have not been well studied. Materials and Methods: This is an ongoing quality improvement breastfeeding project of racially diverse mothers and infants of extremely low birth weight (≤1,000 g). Four epochs were assessed; baseline (B; January 2012-July 2013), transition (T; human milk [HM]-derived fortifier; August 2013-December 2014), Liquid Gold (LG; full bundle, including staff education, colostrum oral care, kangaroo care, antenatal and postpartum counseling, provision of pasteurized donor HM, and breast pumps; January 2015-February 2016), and current (C; ongoing impact, Spanish-speaking lactation consultant, and HM cream; March 2016-April 2019). Results: Four hundred twenty-three mother-infant dyads were assessed. The rate of exclusive mother's own milk at discharge increased significantly in LG compared with previous epochs and was sustained over time. During LG, African American (AA) mothers had a significant surge of breastfeeding initiation (30% in B and 41% in T versus 78% in LG), but this was not sustained in C. AA mothers also experienced a significant decline in the use of exclusive formula feeding in the C epoch (68% in LG versus 46% in C). Hispanic and White mothers sustained their breastfeeding rates over time. Conclusions: Our Liquid Gold lactation bundle led to a significant increase in the provision of HM in the NICU and at discharge in the most vulnerable infants. AA mothers experienced the highest surge in breastfeeding initiation and greatest reduction in formula use. Breastfeeding goals and support need to be tailored to each mother with specific consideration for racial/ethnic background for optimal success.
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Affiliation(s)
- Maria Obaid
- Division of Newborn Medicine, Westchester Medical Center, Maria Fareri Children's Hospital, Valhalla, New York, USA
| | - Teryn Igawa
- New York Medical College School of Medicine, Valhalla, New York, USA
| | - Abigael Maxwell
- Division of Newborn Medicine, Westchester Medical Center, Maria Fareri Children's Hospital, Valhalla, New York, USA
| | - Yuanyi L Murray
- Division of Newborn Medicine, Westchester Medical Center, Maria Fareri Children's Hospital, Valhalla, New York, USA.,Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Amanda Rahman
- Division of Newborn Medicine, Westchester Medical Center, Maria Fareri Children's Hospital, Valhalla, New York, USA.,Department of Neonatal-Perinatal Medicine, Staten Island University Hospital, Staten Island, New York, USA
| | - David Aboudi
- Division of Newborn Medicine, Westchester Medical Center, Maria Fareri Children's Hospital, Valhalla, New York, USA.,NYC DOHMH New York, New York, USA
| | - Karina Olivo
- Division of Newborn Medicine, Westchester Medical Center, Maria Fareri Children's Hospital, Valhalla, New York, USA
| | - Tina Roeder
- Division of Newborn Medicine, Westchester Medical Center, Maria Fareri Children's Hospital, Valhalla, New York, USA
| | - Rhonda Valdes-Greene
- Division of Newborn Medicine, Westchester Medical Center, Maria Fareri Children's Hospital, Valhalla, New York, USA
| | - Heather Brumberg
- Division of Newborn Medicine, Westchester Medical Center, Maria Fareri Children's Hospital, Valhalla, New York, USA
| | - Gad Alpan
- Division of Newborn Medicine, Westchester Medical Center, Maria Fareri Children's Hospital, Valhalla, New York, USA
| | - Boriana Parvez
- Division of Newborn Medicine, Westchester Medical Center, Maria Fareri Children's Hospital, Valhalla, New York, USA
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Hu ZJ, Fusch G, Hu C, Wang JY, El Helou Z, Hassan MT, Mbuagbaw L, El Helou S, Thabane L. Completeness of reporting of quality improvement studies in neonatology is inadequate: a systematic literature survey. BMJ Open Qual 2021; 10:e001273. [PMID: 34127453 PMCID: PMC8204179 DOI: 10.1136/bmjoq-2020-001273] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 06/02/2021] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION Quality improvement (QI) is a growing field of inquiry in healthcare, but the reporting quality of QI studies in neonatology remains unclear. We conducted a systematic survey of the literature to assess the reporting quality of QI studies and factors associated with reporting quality. METHODS We searched Medline for publications of QI studies from 2016 to 16 April 2020. Pairs of reviewers independently screened citations and assessed reporting quality using a 31-item modified Standards for Quality Improvement Reporting Excellence, 2nd edition (SQUIRE 2.0) checklist. We reported the number (percentage) of studies that reported each item and their corresponding 95% CIs. We used Poisson regression to explore factors associated with reporting quality, namely, journal endorsement of SQUIRE 2.0, declaration of funding sources, year of publication and number of authors. The results were reported as incidence rate ratio (IRR) and 95% CI. RESULTS Of 1921 citations, 336 were eligible; among them, we randomly selected 100 articles to assess reporting quality. The mean (standard deviation) number of SQUIRE 2.0 items adhered to was 22.0 (4.5). Percentage of articles reporting each item varied from 26% to 100%. Journal endorsement of SQUIRE 2.0 (IRR=1.11, 95% CI 1.02 to 1.21, p=0.015), declaration of funding sources and increasing number of authors were significantly associated with better reporting. CONCLUSIONS Reporting quality of QI studies in neonatology is inadequate. Endorsing the SQUIRE 2.0 guideline is a step that journals can implement to enhance the completeness of reporting.
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Affiliation(s)
- Zheng Jing Hu
- Department of Health Research Methods Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Gerhard Fusch
- Division of Neonatology, Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Catherine Hu
- Bachelor of Arts and Science, McMaster University, Hamilton, Ontario, Canada
| | - Jie Yi Wang
- Bachelor of Medical Sciences, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Ontario, Canada
| | - Zoe El Helou
- Bachelor of Health Sciences, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Muhammad Taaha Hassan
- Bachelor of Health Sciences, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Lawrence Mbuagbaw
- Department of Health Research Methods Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Salhab El Helou
- Division of Neonatology, Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Lehana Thabane
- Department of Health Research Methods Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
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Catalytic Support for Improving Clinical Care in Special Newborn Care Units (SNCU) Through Composite SNCU Quality of Care Index (SQCI). Indian Pediatr 2021. [DOI: 10.1007/s13312-021-2192-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Saboth MD PK, Sarin PhD E, Alwadhi MD V, Jaiswal MPH A, Mohanty MD JS, Choudhary DCH N, Bisht MBBS N, Gupta MBBS A, Kumar BSc A, Gupta MD S, Kumar MD H. Addressing Quality of Care in Pediatric Units using a Digital Tool: Implementation Experience from 18 SNCU of India. J Trop Pediatr 2021; 67:6139354. [PMID: 33594419 PMCID: PMC7887439 DOI: 10.1093/tropej/fmab005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Lack of quality care is associated with newborn mortality and stillbirth. India launched the Special newborn care unit (SNCU) Quality of Care Index (SQCI) for measuring quality indicators in SNCU. The USAID Vriddhi project provided support to the use of SQCI in 19 SNCU across aspirational districts of Jharkhand, Uttarakhand, Himachal Pradesh, Punjab and Haryana. The objective was to provide holistic support to quality care processes by generating analyzed quarterly reports for action with the goal toward sustainability by capacitating SNCU personnel and program officers to use SQCI, over a 1period from April 2019 to June 2020. The composite index has seven indicators and converts them into indices, each having a range from 0.1 to 1, to measure performance of SNCU.7 of the 18 SNCU improved their composite scores from the first to the last quarter. Rational use of antibiotics showed improvement in 12 SNCU. Survival in newborns >2500 g and <2500, low birth weight admission and optimal bed utilization had the most variations between and within facilities. Based on quarterly data analysis, all facilities introduced KMC, 10 facilities improved equipment and drug supply, 9 facilities launched in-house capacity building to improve asphyxia management. The SQCI implementation helped to show a process of using SQCI data for identifying bottlenecks and addressing quality concerns. The project has transitioned to complete responsibility of SQCI usage by the district and facility teams. Use of an existing mechanism of quality monitoring without any major external support makes the SQCI usable and doable.
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Affiliation(s)
| | - Enisha Sarin PhD
- Health, Nutrition and WASH, IPE Global, New Delhi, India,Correspondence: Enisha Sarin, IPE Global, D-84, Defence Colony, New Delhi 110024, India. Tel: +91-9871992484. E-mail: <>
| | - Varun Alwadhi MD
- Pediatrics, Dr Ram Manohar Lohia Hopsital and Post-Graduate Institute, New Delhi, India
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Doetsch JN, Marques SCS, Krafft T, Barros H. Impact of macro-socioeconomic determinants on sustainable perinatal health care in Portugal: a qualitative study on the opinion of healthcare professionals and experts. BMC Public Health 2021; 21:210. [PMID: 33494727 PMCID: PMC7836450 DOI: 10.1186/s12889-021-10194-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 01/07/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The WHO identified the importance of macro-socioeconomic determinants and political context as interlinked key factors affecting healthcare quality and health equity. As a response to the recent economic and financial crisis, Portugal approved in 2011 the Economic Adjustment Programme (EAP) to obtain financial assistance from the Troika in order to reduce public debt. This study aims to analyse the impact of the economic crisis and the EAP on perinatal healthcare quality for very preterm (VPT) and/or very low birth weight (VLBW) infants, as perceived by healthcare professionals and experts, within the health administrative regions of the two major metropolitan areas in Portugal. METHODS A qualitative approach was applied to receive an in-depth understanding and accomplish perspective variability. A purposive sampling technique was used. Semi-structured interviews were conducted with twenty-one healthcare professionals and experts between October 2018-July 2019. Inductive thematic analysis was performed which encompassed a five-step categorization procedure. Data analysis was undertaken by utilizing Nvivo2011 software. Evolved themes were then associated with WHO's Quality Standards on Maternal and New-born Care. A framework on the impact of macro-socioeconomic determinants on perinatal health care quality was developed. RESULTS Although participants did not perceive the quality of perinatal care had deteriorated, the analysis of their accounts on work experience revealed that it was indeed adversely modified in all WHO Quality Standards. Health care provision was perceived as detrimental in five main areas: 1) Availability of human resources; 2) Functional referral systems; 3) Competent and motivated human resources; 4) Emotional support; and 5) Essential physical resources available. Policy reforms by the EAP resulted in reduced timeliness of care, increased waiting times, cuts in sequence and duration of consultations, and deficiencies in follow-up care for VPT/VLBW infants and their mothers. The EAP directly influenced working environment of healthcare professionals by causing stress, burnout, work absence, and brain drain. CONCLUSION An interrelation between macro-socioeconomic determinants and perinatal health care quality was disclosed. The economic crisis and EAP have adversely modified equitable perinatal health care quality for VPT/VLBW infants and their mothers. Our findings underlined the negative impact of austerity policies on vulnerable populations.
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Affiliation(s)
- Julia Nadine Doetsch
- EPIUnit - Instituto de Saúde Pública da Universidade do Porto (ISPUP), Rua das Taipas 135, 4050-091, Porto, Portugal.
- Maastricht University, Faculty of Health, Medicine and Life Sciences (FHML), Care and Public Health Research Institute (CAPHRI), Maastricht, The Netherlands.
| | - Sandra C S Marques
- EPIUnit - Instituto de Saúde Pública da Universidade do Porto (ISPUP), Rua das Taipas 135, 4050-091, Porto, Portugal
- Centro em Rede de Investigação em Antropologia (CRIA) - Instituto Universitário de Lisboa, Lisbon, Portugal
| | - Thomas Krafft
- Maastricht University, Faculty of Health, Medicine and Life Sciences (FHML), Care and Public Health Research Institute (CAPHRI), Maastricht, The Netherlands
| | - Henrique Barros
- EPIUnit - Instituto de Saúde Pública da Universidade do Porto (ISPUP), Rua das Taipas 135, 4050-091, Porto, Portugal
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto (FMUP), Porto, Portugal
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Apedani DB, Koduah A, Druye AA, Ebu NI. Experiences of mothers with preterm babies on support services in Neonatal Intensive Care Unit of a mission hospital in Ghana. INTERNATIONAL JOURNAL OF AFRICA NURSING SCIENCES 2021. [DOI: 10.1016/j.ijans.2021.100366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Webbe JWH, Duffy JMN, Afonso E, Al-Muzaffar I, Brunton G, Greenough A, Hall NJ, Knight M, Latour JM, Lee-Davey C, Marlow N, Noakes L, Nycyk J, Richard-Löndt A, Wills-Eve B, Modi N, Gale C. Core outcomes in neonatology: development of a core outcome set for neonatal research. Arch Dis Child Fetal Neonatal Ed 2020; 105:425-431. [PMID: 31732683 PMCID: PMC7363790 DOI: 10.1136/archdischild-2019-317501] [Citation(s) in RCA: 115] [Impact Index Per Article: 28.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 10/01/2019] [Accepted: 10/30/2019] [Indexed: 11/05/2022]
Abstract
BACKGROUND Neonatal research evaluates many different outcomes using multiple measures. This can prevent synthesis of trial results in meta-analyses, and selected outcomes may not be relevant to former patients, parents and health professionals. OBJECTIVE To define a core outcome set (COS) for research involving infants receiving neonatal care in a high-income setting. DESIGN Outcomes reported in neonatal trials and qualitative studies were systematically reviewed. Stakeholders were recruited for a three-round international Delphi survey. A consensus meeting was held to confirm the final COS, based on the survey results. PARTICIPANTS Four hundred and fourteen former patients, parents, healthcare professionals and researchers took part in the eDelphi survey; 173 completed all three rounds. Sixteen stakeholders participated in the consensus meeting. RESULTS The literature reviews identified 104 outcomes; these were included in round 1. Participants proposed 10 additional outcomes; 114 outcomes were scored in rounds 2 and 3. Round 1 scores showed different stakeholder groups prioritised contrasting outcomes. Twelve outcomes were included in the final COS: survival, sepsis, necrotising enterocolitis, brain injury on imaging, general gross motor ability, general cognitive ability, quality of life, adverse events, visual impairment/blindness, hearing impairment/deafness, retinopathy of prematurity and chronic lung disease/bronchopulmonary dysplasia. CONCLUSIONS AND RELEVANCE A COS for clinical trials and other research studies involving infants receiving neonatal care in a high-income setting has been identified. This COS for neonatology will help standardise outcome selection in clinical trials and ensure these are relevant to those most affected by neonatal care.
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Affiliation(s)
| | - James M N Duffy
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, Oxfordshire, UK
| | - Elsa Afonso
- Neonatal Unit, Rosie Hospital, Cambridge, Cambridgeshire, UK
| | - Iyad Al-Muzaffar
- The Neonatal Unit, Royal Glamorgan Hospital, Llantrisant, Rhondda Cynon Taf, UK
| | - Ginny Brunton
- UCL Institute of Education Centre for Longitudinal Studies, London, UK
| | - Anne Greenough
- Department of Women and Children's Health, School of Life Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Nigel J Hall
- Paediatric Surgery, Southampton General Hospital, Southampton, UK
| | | | - Jos M Latour
- School of Nursing and Midwifery, Faculty of Health, Education and Society, Plymouth University, Plymouth, Devon, UK
- School of Nursing and Midwifery, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | | | - Neil Marlow
- Institute for Women's Health, University College London, London, UK
| | | | - Julie Nycyk
- Neonatal Unit, Birmingham City Hospital, Birmingham, UK
| | | | | | - Neena Modi
- Neonatal Medicine, Imperial College London, London, UK
| | - Chris Gale
- Academic Neonatal Medicine, Imperial College London, London, UK
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Horvat A, Filipovic J. Healthcare system quality indicators: the complexity perspective. TOTAL QUALITY MANAGEMENT & BUSINESS EXCELLENCE 2020. [DOI: 10.1080/14783363.2017.1421062] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Ana Horvat
- Department for Quality Management and Standardization, Faculty of Organizational Sciences, University of Belgrade, Belgrade, Serbia
| | - Jovan Filipovic
- Department for Quality Management and Standardization, Faculty of Organizational Sciences, University of Belgrade, Belgrade, Serbia
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Soll RF, McGuire W. Evidence-Based Practice: Improving the Quality of Perinatal Care. Neonatology 2019; 116:193-198. [PMID: 31167207 DOI: 10.1159/000496214] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 12/14/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND For clinical research findings to improve the quality of care and outcomes for newborn infants and their families, they need to be implemented in policy and adopted in practice. METHODS We describe the principles of effective dissemination and implementation of research findings and highlight examples of collaborative quality improvement strategies to ensure that guidelines, protocols, policies and practices reflect research-informed evidence. RESULTS Passive dissemination of research findings is generally ineffective in driving change. Implementation strategies that use multi-faceted approaches acting on different barriers to change are better at driving improvements in the quality of care practices. These initiatives are increasingly embedded within regional, national and international networks of neonatal care centres that collaborate in conducting research, implementing its findings and auditing its uptake. Examples of successful network-based collaborative quality improvement programmes include efforts to increase use of evidence-based strategies to prevent hospital-acquired bloodstream infections, optimise surfactant replacement for preterm infants, reduce the incidence of bronchopulmonary dysplasia, improve antibiotic stewardship and promote the use of human milk to prevent necrotising enterocolitis in very-low-birth-weight infants. CONCLUSIONS Effective dissemination and implementation are essential for research evidence to improve quality of care and outcomes for newborn infants and their families. Multifaceted initiatives within network-based collaborative quality improvement programmes facilitate continuous audit and benchmarking cycles to ensure equity of access to evidence-based care practices.
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Affiliation(s)
- Roger F Soll
- Vermont Oxford Network, Burlington, Vermont, USA.,Department of Pediatrics, Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
| | - William McGuire
- Centre for Reviews and Dissemination, University of York, York, United Kingdom,
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Kukla A, Dowling DA, Dolansky MA. The History and State of Neonatal Nursing Quality Improvement Practice and Education. Neonatal Netw 2018; 37:78-84. [PMID: 29615155 DOI: 10.1891/0730-0832.37.2.78] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Quality improvement has evolved rapidly in neonatal nursing. This review outlines the history and current state of quality improvement practice and education in neonatal nursing. The future of neonatal nursing includes a stronger emphasis on quality improvement in advanced practice education that promotes doctoral projects that result in clinical improvements. A collective focus will ensure that neonatal nurses not only deliver evidence-based care, but also continually improve the care they deliver.
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Fry TJ, Marfurt S, Wengier S. Systematic Review of Quality Improvement Initiatives Related to Cue-Based Feeding in Preterm Infants. Nurs Womens Health 2018; 22:401-410. [PMID: 30138603 DOI: 10.1016/j.nwh.2018.07.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Revised: 07/08/2018] [Accepted: 07/01/2018] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To examine and synthesize the outcomes of quality improvement (QI) initiatives related to cue-based feeding of preterm infants to facilitate implementation of findings to improve nursing practice. DATA SOURCES Cumulative Index of Nursing and Allied Health Literature (CINAHL) Complete and PubMed were searched for full-text articles published from 2000 through 2017 included under the medical subject heading quality improvement and whose titles included any form of the term feeding combined with any of the following: bottle, breast, cue-based, demand, infant, neonate, newborn, oral, or responsive. STUDY SELECTION Articles were considered for inclusion if they were published in English-language journals and focused on QI initiatives concerning cue-based feeding of preterm infants in NICU settings. DATA EXTRACTION After initial article review, we examined clinical outcomes and assessed study methodology using the Quality Improvement Minimum Quality Criteria Set (QI-MQCS) framework. DATA SYNTHESIS Our review yielded seven studies related to cue-based feeding of preterm infants. Five studies included multidisciplinary stakeholder teams to assess their respective NICU environments and facilitate project completion. In two studies, feeding "champions" were designated as facilitators. In one study, researchers used a Plan-Do-Study-Act approach and emphasized process over outcome. In six studies, researchers measured hospital length of stay, which decreased in five intervention groups. In three studies, researchers measured infant weight gain, which increased in two intervention groups. In two studies, researchers monitored weight gain velocity, and in five studies, researchers reported earlier gestational attainment of full oral feedings. CONCLUSION Weight gain, time to full oral feedings, and hospital length of stay may be improved with the use of cue-based feeding. QI initiatives are a practical means to bring best evidence and multidisciplinary collaboration to the NICU.
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Picarillo AP. Introduction to quality improvement tools for the clinician. J Perinatol 2018; 38:929-935. [PMID: 29795322 DOI: 10.1038/s41372-018-0100-4] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 02/12/2018] [Accepted: 02/21/2018] [Indexed: 12/19/2022]
Abstract
As physicians continue search for ways to deliver high quality care to their patients and families, newer tools and methods are being introduced. Initially developed by manufacturing, quality improvement methods have been slowly adopted by healthcare and are now standard curriculum in medical schools. The IHI Model for Improvement allows for teams to create. model for change, test proposed changes in clinical situations, measure the results and then accept or modify the proposed changes. Additional tools such as process maps, Pareto charts, Ishikawa diagrams, and key driver diagrams provide structure and visual representation to the team during the creation and implementation of. quality improvement initiative. As participation in quality improvement is becoming an expectation for all health care providers, familiarity with these tools will assist teams with implementing improved processes in their local systems of care.
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Affiliation(s)
- Alan Peter Picarillo
- Division of Neonatology, Barbara Bush Children's Hospital, Maine Medical Center, 22 Bramhall Street, Portland, ME, 04102, USA.
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17
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Horvat A, Filipovic J. Service quality and maturity of health care organizations through the lens of Complexity Leadership Theory. J Eval Clin Pract 2018; 24:301-307. [PMID: 28714561 DOI: 10.1111/jep.12789] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 05/30/2017] [Accepted: 05/30/2017] [Indexed: 11/28/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES This research focuses on Complexity Leadership Theory and the relationship between leadership-examined through the lens of Complexity Leadership Theory-and organizational maturity as an indicator of the performance of health organizations. METHODS The research adopts a perspective that conceptualizes organizations as complex adaptive systems and draws upon a survey of opinion of 189 managers working in Serbian health organizations. RESULTS AND CONCLUSIONS As the results indicate a dependency between functions of leadership and levels of the maturity of health organizations, we propose a model that connects the two. The study broadens our understanding of the implications of complexity thinking and its reflection on leadership functions and overall organizational performance. The correlations between leadership functions and maturity could have practical applications in policy processing, thus improving the quality of outcomes and the overall level of service quality.
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Affiliation(s)
- Ana Horvat
- University of Belgrade, Faculty of Organizational Sciences, Belgrade, Serbia
| | - Jovan Filipovic
- University of Belgrade, Faculty of Organizational Sciences, Belgrade, Serbia
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Haumont D, NguyenBa C, Modi N. eNewborn: The Information Technology Revolution and Challenges for Neonatal Networks. Neonatology 2017; 111:388-397. [PMID: 28538233 DOI: 10.1159/000464267] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Among preterm infants, 1-2% are born before 32 weeks of gestation or have a birth weight below 1,500 g. They contribute disproportionately to the burden of mortality and morbidity related to preterm birth, whether in the neonatal period or later in life. They are the target population studied in neonatal networks. Improving neonatal care and later outcome is a major issue in public health. Neonatologists, health care providers, public authorities, parents and families, industry, and all organizations dedicated to infant health must bring their efforts together and dedicate their actions in order to do so. Neonatal networks are the strongest platforms through which to achieve this goal. The progressive information technology (IT) revolution is leading to a new approach. The power of search engines and new technological devices opens extraordinary new perspectives in terms of speed, storing, sharing, and innovative approaches in providing health care. However, difficulties are expected with old applications that cannot evolve in the new IT environment. Security and privacy in data collection are future challenges to be addressed. Here, we describe the eNewborn project and its original software. The main functionalities are interactive navigation, harmonization with other formats, linkage with other databases, and strict security and privacy procedures.
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Swanson JR, Pearlman SA. Roadmap to a successful quality improvement project. J Perinatol 2017; 37:112-115. [PMID: 27906193 DOI: 10.1038/jp.2016.216] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Accepted: 10/17/2016] [Indexed: 11/09/2022]
Abstract
Although the benefits of quality improvement initiatives are largely understood by practicing neonatologists and perinatologists, the vast majority have not received any formal training in quality improvement methodology. Even as reporting requirements of quality metrics has increased from a number of outside agencies and public reporting entities, education for physicians regarding how to carry out quality improvement projects has largely remained the individual's responsibility. The first in a series of quality improvement education papers, we focus on the reasons why quality improvement matters and how to develop a team of stakeholders that will be functional and productive in addressing specific quality and safety concerns.
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Affiliation(s)
- J R Swanson
- Department of Pediatrics, University of Virginia Children's Hospital, Charlottesville, VA, USA
| | - S A Pearlman
- Department of Pediatrics, Christiana Care Health System, Newark, DE, USA
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Raaijmakers A, Allegaert K. Catch-Up Growth in Former Preterm Neonates: No Time to Waste. Nutrients 2016; 8:nu8120817. [PMID: 27999303 PMCID: PMC5188471 DOI: 10.3390/nu8120817] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Accepted: 12/14/2016] [Indexed: 11/20/2022] Open
Affiliation(s)
- Anke Raaijmakers
- Department of Pediatrics, University Hospitals Leuven, Leuven B-3000, Belgium.
- Department of Development and Regeneration, KU Leuven, Leuven B-3000, Belgium.
| | - Karel Allegaert
- Department of Development and Regeneration, KU Leuven, Leuven B-3000, Belgium.
- Intensive Care and Department of Pediatric Surgery, Erasmus MC Sophia Children's Hospital, Rotterdam 3015 CN, The Netherlands.
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