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Clinical Trial
. 2009 Oct 13;181(8):469-76.
doi: 10.1503/cmaj.081727. Epub 2009 Aug 10.

Improving the quality of care for infants: a cluster randomized controlled trial

Shoo K Lee  1 , Khalid Aziz, Nalini Singhal, Catherine M Cronin, Andrew James, David S C Lee, Derek Matthew, Arne Ohlsson, Koravangattu Sankaran, Mary Seshia, Anne Synnes, Robin Walker, Robin Whyte, Joanne Langley, Ying C MacNab, Bonnie Stevens, Peter von Dadelszen
Affiliations
Clinical Trial

Improving the quality of care for infants: a cluster randomized controlled trial

Shoo K Lee et al. CMAJ. .

Abstract

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.

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Figures

Figure 1
Figure 1
Consort flow chart for the cluster randomized trial of the Evidence-based Practice for Improving Quality method.
Figure 2
Figure 2
Probability of nosocomial infection at individual hospitals over time when percutaneously inserted central catheters are used (thick lines) compared to when they are not used (thin lines).
See this image and copyright information in PMC

Comment in

  • Bridging the gaps: getting evidence into practice.
    McGuire W, Fowlie PW. McGuire W, et al. CMAJ. 2009 Oct 13;181(8):457-8. doi: 10.1503/cmaj.091243. Epub 2009 Aug 10. CMAJ. 2009. PMID: 19667032 Free PMC article. No abstract available.
  • The inverse groups?
    Wirtschafter DD. Wirtschafter DD. CMAJ. 2009 Sep 15;181(6-7):399. doi: 10.1503/cmaj.109-2016. CMAJ. 2009. PMID: 19752146 Free PMC article. No abstract available.

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