Regional Variation in Antenatal Corticosteroid Use: A Network-Level Quality Improvement Study

Profit, Jochen; Goldstein, Ben; Tamaresis, John; Kan, Peiyi; Lee, H.C.

doi:10.1542/peds.2014-2177

Cited by 36 publications

(29 citation statements)

References 17 publications

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“…First, prior literature and general advances in high risk maternal care, including greater use of antenatal corticosteroids (24) and imaging, may have fostered more appropriate utilization and regionalization patterns. Compared with prior studies (3, 4), we found an inconsistent association between level of care and survival.…”

Section: Discussionmentioning

confidence: 99%

The Association of Level of Care With NICU Quality

et al. 2016

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Background and Objectives Regionalized care delivery purportedly optimizes care to vulnerable very low birth weight (VLBW; < 1500g) infants. However, a comprehensive assessment of quality of care delivery across different levels of Neonatal Intensive Care Units (NICUs) has not been done. Methods We conducted a cross-sectional analysis of 21,051 VLBW infants in 134 California NICUs. NICUs designated their level of care according to 2012 AAP guidelines. We assessed quality of care delivery via the Baby-MONITOR, a composite indicator, which combines nine risk-adjusted measures of quality. Baby-MONITOR scores are measured as observed minus expected performance, expressed in standard units with a mean of zero and a standard deviation of one. Results Wide variation in Baby-MONITOR scores exists across California (mean (SD) 0.18 (1.14), range -2.26 to 3.39). However, level of care was not associated with overall quality scores. Subcomponent analysis revealed trends for higher performance of Level IV NICUs on several process measures, including antenatal steroids and any human milk feeding at discharge, but lower scores for several outcomes including any health care associated infection, pneumothorax, and growth velocity. No other health system or organizational factors including hospital ownership, neonatologist coverage, urban or rural location, and hospital teaching status, were significantly associated with Baby-MONITOR scores. Conclusion The comprehensive assessment of the effect of level of care on quality reveals differential opportunities for improvement and allows monitoring of efforts to ensure that fragile VLBW infants receive care in appropriate facilities.

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Section: Discussionmentioning

confidence: 99%

The Association of Level of Care With NICU Quality

et al. 2016

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“…Based on 2013 data from the Vermont Oxford Network registry of over 54 000 infants cared for in 950 NICUs, rates of ANCS administration among infants 24–33 weeks gestation averages 83% with the lowest quartile of centres having rates below 76% 25. Similarly, a recent study of over 33 000 infants in 120 hospitals in California found significant variation in ANCS rates with regional ANCS rates ranging from 68% to 93% 26. This suggests that there is still room for improvement and other centres could benefit from creating the processes and supporting conditions that enabled OPQC hospitals to achieve high rates of ANCS administration.…”

Section: Discussionmentioning

confidence: 99%

Reliable implementation of evidence: a qualitative study of antenatal corticosteroid administration in Ohio hospitals

Kaplan

Sherman²,

Cleveland

et al. 2015

BMJ Qual Saf

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“…[35][36][37] Similarly, the incidence of items on the Top Five list will vary across centers. In applying the results, we would encourage centers to first measure incidence of use.…”

Section: Discussionmentioning

confidence: 99%

Choosing Wisely in Newborn Medicine: Five Opportunities to Increase Value

et al. 2015

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BACKGROUND: The use of unnecessary tests and treatments contributes to health care waste. The “Choosing Wisely” campaign charges medical societies with identifying such items. This report describes the identification of 5 tests and treatments in newborn medicine. METHODS: A national survey identified candidate tests and treatments. An expert panel of 51 individuals representing 28 perinatal care organizations narrowed the list over 3 rounds of a modified Delphi process. In the final round, the panel was provided with Grading of Recommendation, Assessment, Development and Evaluation (GRADE) literature summaries of the top 12 tests and treatments. RESULTS: A total of 1648 candidate tests and 1222 treatments were suggested by 1047 survey respondents. After 3 Delphi rounds, the expert panel achieved consensus on the following top 5 items: (1) avoid routine use of antireflux medications for treatment of symptomatic gastroesophageal reflux disease or for treatment of apnea and desaturation in preterm infants, (2) avoid routine continuation of antibiotic therapy beyond 48 hours for initially asymptomatic infants without evidence of bacterial infection, (3) avoid routine use of pneumograms for predischarge assessment of ongoing and/or prolonged apnea of prematurity, (4) avoid routine daily chest radiographs without an indication for intubated infants, and (5) avoid routine screening term-equivalent or discharge brain MRIs in preterm infants. CONCLUSIONS: The Choosing Wisely Top Five for newborn medicine highlights tests and treatments that cannot be adequately justified on the basis of efficacy, safety, or cost. This list serves as a starting point for quality improvement efforts to optimize both clinical outcomes and resource utilization in newborn care.

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Regional Variation in Antenatal Corticosteroid Use: A Network-Level Quality Improvement Study

Cited by 36 publications

References 17 publications

The Association of Level of Care With NICU Quality

The Association of Level of Care With NICU Quality

Reliable implementation of evidence: a qualitative study of antenatal corticosteroid administration in Ohio hospitals

Choosing Wisely in Newborn Medicine: Five Opportunities to Increase Value

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