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

¹ From the Departments of Paediatrics, University of Toronto, Toronto, Ont
² Memorial University, St John's, NL
³ University of Calgary, Calgary, Alta.
⁴ University of Manitoba, Winnipeg, Man.
⁵ University of Western Ontario, London, Ont.
⁶ University of British Columbia, Vancouver, BC
⁷ University of Saskatchewan, Saskatoon, Sask.
⁸ University of Ottawa, Ottawa, Ont.
⁹ Dalhousie University, Halifax, NS
¹⁰ Department of Health Care and Epidemiology, University of British Columbia, Vancouver, BC
¹¹ Department of Nursing, University of Toronto, Toronto, Ont.
¹² Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC

	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.