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. Interpretation: 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.
Although methods for continuous quality improvement have been used to improve outcomes, (1-3) some, such as the National Institutes of Child Health and Human Development Quality Collaborative, (4) have reported [...]