Baby-MONITOR: A Composite Indicator of NICU Quality

American Academy of Pediatrics (AAP) - Tập 134 Số 1 - Trang 74-82 - 2014
Jochen Profit1,2, Marc Kowalkowski3, John A. F. Zupancic4,5, Kenneth Pietz6,7, Peter J. Richardson6,7, David Draper8,9, Sylvia J. Hysong4,5, Eric J. Thomas10, Laura A. Petersen4,5, Jeffrey B. Gould1,2
1California Perinatal Quality Care Collaborative; Palo Alto, California;
2California Perinatal Quality Care Collaborative; Palo Alto, California;; 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;
3Levine Cancer Institute, Carolinas HealthCare System, Charlotte, North Carolina
4Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts;; Division of Newborn Medicine, Harvard Medical School, Boston, Massachusetts;
5Division of Newborn Medicine, Harvard Medical School, Boston, Massachusetts;
6Houston Veterans Affairs (VA) Health Services Research and Development Center of Excellence, Health Policy and Quality Program, Michael E. DeBakey VA Medical Center; Houston, Texas;
7Houston Veterans Affairs (VA) Health Services Research and Development Center of Excellence, Health Policy and Quality Program, Michael E. DeBakey VA Medical Center; Houston, Texas;; Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, Texas;
8Department of Applied Mathematics and Statistics, Baskin School of Engineering, University of California, Santa Cruz, California;; eBay Research Labs, San Jose, California;
9eBay Research Labs, San Jose, California;
10University of Texas at Houston – Memorial Hermann Center for Healthcare Quality and Safety, University of Texas Medical School, Houston, Texas

Tóm tắt

BACKGROUND AND OBJECTIVES: 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.

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American Academy of Pediatrics (AAP)

Tập 134 Số 1

74-82

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