CMAJ • October 13, 2009; 181 (8). First published August 10, 2009; doi:10.1503/cmaj.081727
© 2009 Canadian Medical Association or its licensors
All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association.
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Research

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

Shoo K. Lee, MBBS PhD, Khalid Aziz, MBBS, Nalini Singhal, MBBS, Catherine M. Cronin, MD MBA, Andrew James, MBChB MBI, David S.C. Lee, MBBS, Derek Matthew, MBBS, Arne Ohlsson, MD MSc, Koravangattu Sankaran, MBBS, Mary Seshia, MBChB, Anne Synnes, MDCM MHSc, Robin Walker, MBChB, Robin Whyte, MBBS, Joanne Langley, MD MSc, Ying C. MacNab, PhD, Bonnie Stevens, PhD and Peter von Dadelszen, MBChB DPhil

From the Departments of Paediatrics (Lee, James, Ohlsson), University of Toronto, Toronto, Ont; Memorial University (Aziz), St John’s, NL; University of Calgary (Singhal), Calgary, Alta.; University of Manitoba (Cronin, Seshia), Winnipeg, Man.; University of Western Ontario (Lee), London, Ont.; University of British Columbia (Matthew, Synnes), Vancouver, BC; University of Saskatchewan (Sankaran), Saskatoon, Sask.; University of Ottawa (Walker), Ottawa, Ont.; Dalhousie University (Whyte, Langley), Halifax, NS; Department of Health Care and Epidemiology (MacNab), University of British Columbia, Vancouver, BC; Department of Nursing (Stevens), University of Toronto, Toronto, Ont.; and the Department of Obstetrics and Gynecology (von Dadelszen), University of British Columbia, Vancouver, BC

Correspondence to: Dr. Shoo K. Lee, Department of Paediatrics, Mt. Sinai Hospital, 782-600 University Ave., Toronto ON M5G 1X5; fax 416 586-8745; sklee{at}mtsinai.on.ca

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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