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Establishment of national consensus of quality measures in the treatment of very low birth weight infants
Researchers: Brian Reichman1,2, Shaul Dollberg 3
- The Gertner Institute for Epidemiology and Health Policy Research
- Edmond and Lily Safra Children's Hospital, Sheba Medical Center
- Rabin Medical Center
Background: In neonatal medicine, standard measures have been endorsed for institutions to use in monitoring and improving quality and safety.
Objectives: The aim of this study was to identify consensually agreed quality measures for neonatal intensive care and to subsequently incorporate the selected measures in the Israel very low birth weight infant database.
Method: The selection of quality indicators was undertaken using the RAND/UCLA appropriateness methodology which classifies consensus on the basis of median ratings and the presence or absence of disagreement. A panel of physician directors and head nurses of neonatal intensive care units (NICU's) rated selected measures of quality of care by reliability, validity, scientific soundness, usability and an overall score. Consensus was ranked firstly by the highest median scores, secondly by lowest Disagreement Index values and finally by the lowest Mean Absolute Deviation from the median estimate.
Findings: Completed forms were received from 30 physicians and 8 nurses. In total 23 of the 27 neonatal departments were represented in this study sample.
The 12 quality measures selected with the highest levels of consensus included the 11 highest rated items by physicians and 9 of the 12 highest rated measurements by the nurses. The measure receiving the highest ranking by physicians was “percent of mothers receiving antenatal steroids”. Four of the selected measures were related to hospital acquired infections: Percent of infants with late onset sepsis, rate of episodes of late onset sepsis, rate of central line associated blood stream infections and measures of hand hygiene. Three measurements reflect routinely performed assessments in the NICU: eye examination, cranial ultrasound examination and 1st hour temperature measurement.
The 12 quality measures selected with the highest levels of consensus included the 11 highest rated items by physicians and 9 of the 12 highest rated measurements by the nurses. The measure receiving the highest ranking by physicians was “percent of mothers receiving antenatal steroids”. Four of the selected measures were related to hospital acquired infections: Percent of infants with late onset sepsis, rate of episodes of late onset sepsis, rate of central line associated blood stream infections and measures of hand hygiene. Three measurements reflect routinely performed assessments in the NICU: eye examination, cranial ultrasound examination and 1st hour temperature measurement.
Conclusions: This study showed a high level of consensus among senior neonatologists in the identification of measures which could be used as indicators of quality in NICU's and serve as benchmarking indicators for the evaluation of future interventions.
Research number: A/32/2013
Research end date: 07/2015