Strategies for Addressing Barriers to Publishing Pediatric Quality Improvement Research

Cleave, Jeanne Van; Dougherty, Denise; Perrin, James M.

doi:10.1542/peds.2010-0809

Cited by 19 publications

(14 citation statements)

References 53 publications

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“…Even when CQI projects are disappointing, publishing well-documented experience disseminates valuable experience, an essential goal encouraged by EBM experts. 8, 9, 10, 11 …”

Section: Discussionmentioning

confidence: 99%

The quest for sustained multiple morbidity reduction in very low-birth-weight infants: the Antifragility project

et al. 2017

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Objective:Can a comprehensive, explicitly directive evidence-based guideline for all therapies that might affect the major morbidities of very low-birth-weight (VLBW) infants help a neonatal intensive care unit (NICU) further improve generally favorable morbidity rates? Can Antifragility principles of provider adaptive growth from stressors, enhanced infant risk assessment and adherence to effective therapies minimize unproven treatments and reduce all morbidities?Study Design:Prospectively planned observational trial in VLBW infants: control group born October 2011 to September 2013 and study group October 2013 to September 2015. Multi-disciplinary evidence-based review assigned all NICU treatments into one of four distinct categories: (1) always employ this therapy for VLBW infants, (2) never use this therapy, (3) employ this questionable therapy thoughtfully, only in certain circumstances and (4) this therapy has insufficient evidence of efficacy and safety. Extensive staff education emphasized evidence-based potentially better practice (PBP) selection with compliance checks, appreciation of intertwined co-morbidities and prioritizing infant risk reduction strategies.Results:Control included 221 infants, mean (s.d.) age 29 (2.6) weeks, birth weight 1129 (257) g and Study included 197 infants, 29 (2.7) weeks, 1093 (292) g. One hundred and four distinct therapies were placed into categories 1 to 4, with 32 specific compliance checks. Overall mean compliance with the process checks during the second era was 70%, high: 100% (exclusive breast milk use), low: 24% (correct pulse oximetry alarm settings). Morbidity and mortality rates did not significantly change during the second era.Conclusions:In our NICU with favorable morbidity rates, an expanded effort using a comprehensive therapy guideline for VLBW infants did not further improve outcomes. We need deeper understanding of continuous quality improvement (CQI) fundamentals, therapy compliance, co-morbidity relationships and enhanced sensitivity of risk assessment. Our innovative Antifragility PBP guideline could be useful to other NICUs seeking improvement in VLBW infant morbidities, as we offer a reasoned and concise template of a broad array of therapies categorized efficiently for transparency and review, designed to enhance responsible CQI decision-making.

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“…Even when CQI projects are disappointing, publishing well-documented experience disseminates valuable experience, an essential goal encouraged by EBM experts. 8, 9, 10, 11 …”

Section: Discussionmentioning

confidence: 99%

The quest for sustained multiple morbidity reduction in very low-birth-weight infants: the Antifragility project

et al. 2017

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“…13 Conducting and publishing QI efforts is an important task to promote transparency and disseminate knowledge as to why interventions succeed or fail, and if rigorous pre-and postintervention data collection are analyzed, then bias and confounders are reduced. 14 Emphasize noninvasive respiratory support using NCPAP. Continue fluid restriction advancing gradually up to 120-130 mL/kg/day total fluids while the PDA is present.…”

Section: Discussionmentioning

confidence: 99%

Permissive tolerance of the patent ductus arteriosus may increase the risk of Chronic Lung Disease

Kaempf¹,

Huston²,

Wu³

et al. 2013

RRN

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“…Few QI projects reach publication, however, partly because the design, types of intervention, data collection and analysis related to QI do not fit traditional publication guidelines. Van Cleave et al 16 identified other barriers to publishing, including small-scale local initiatives, and strategies to overcome these, including working in networks and creating incentives.…”

Section: Sharing Learningmentioning

confidence: 99%

Supporting colleagues to improve care: educating for quality improvement

Runnacles

Roueché

2014

Arch Dis Child Educ Pract Ed

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Clinicians at the front line of healthcare delivery are very well positioned to identify and improve the system in which they work. Training curricula, however, have not always equipped them with the skills or knowledge to implement change. This article looks at educational approaches to support clinicians to be actively involved with quality improvement (QI). It looks at the role of doctors in postgraduate training (DrPGT) and their educational supervisors and builds on the topics discussed throughout the 'EQUIPPED' article series. Factors for success of a QI education programme and practical ideas for overcoming barriers to supporting clinicians in QI are discussed. We present examples of educational initiatives and a framework for evaluating such programmes, and we examine the role of faculty development to help inspire and support colleagues to improve care.

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Strategies for Addressing Barriers to Publishing Pediatric Quality Improvement Research

Abstract: Specific, feasible approaches can be used to improve opportunities for publication in pediatric, QI, and general medical journals.

Cited by 19 publications

References 53 publications

The quest for sustained multiple morbidity reduction in very low-birth-weight infants: the Antifragility project

The quest for sustained multiple morbidity reduction in very low-birth-weight infants: the Antifragility project

Permissive tolerance of the patent ductus arteriosus may increase the risk of Chronic Lung Disease

Supporting colleagues to improve care: educating for quality improvement

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