Jump to comment:
- Page navigation anchor for RE: Quality-improvement in the treatment of preterm infants is appauded but prevention of preterm birth needs to be improvedRE: Quality-improvement in the treatment of preterm infants is appauded but prevention of preterm birth needs to be improved
We thank Dr. Wilson for his comments on Jan. 27, 2020, and for highlighting the need for research funding at the ‘beginning of life’ stages. Indeed, according to the Heckman Curve, the return on human capital investment is highest when made at the earliest stages of life (1), and Barker’s Developmental Origins of Health and Disease (DOHaD) hypothesis (2) about the impact of fetal and early childhood programming on adult-onset chronic diseases reinforces the need for investing in the early life stages. Dr. Brindle’s comments about the need for sustained effort and investment to improve quality of care (3) are equally prescient. Networks and databases need time to mature and demonstrate their impact. Short-term, episodic, and project-based funding do not lead to sustained improvements or advancements. The Canadian Neonatal Network’s ability to receive continuous funding from the Canadian Institutes of Health Research, provincial funding agencies, and participating hospitals was an important reason for its success. The Canadian Institutes of Health Research’s Strategy for Patient Oriented Research (SPOR) program (4), which provides federal and provincial funding for research networks to examine and implement innovative ways of improving care and patient outcomes, is a step in the right direction. It will be important to sustain these efforts for a sufficient duration to demonstrate results. A future funding envelope that supports clinical-research networks and databases as in...
Show MoreCompeting Interests: None declared. - Page navigation anchor for Quality-improvement in the treatment of preterm infants is appauded but prevention of preterm birth needs to be improvedQuality-improvement in the treatment of preterm infants is appauded but prevention of preterm birth needs to be improved
The network-wide quality-improvement activities by the Canadian neonate network and their EPIQ process has created new and important knowledge for the treatment of our smallest and most 'delicate' patients. The Plan-Do-Study-Act cycles have been important to the facilitation of quality improvement.
Show More
Maternity providers have become involved in the EPIQ process with delivery directed practices to enhance preterm neonates physiology as reported antenatal steroids at appropriate times and doses but are adding new considerations such as delayed cord clamping through the associated Maternal Fetal Medicine Network.
The overall message for this respond is that more priority and direction of clinical and research funding needs to be directed to the 'beginning of life' by federal and provincial administrations. In addition to supporting the EPIQ neonatal treatment successes, there needs to be more clinical support and research activity for team-based multi-focused prevention of preterm birth. Clinical care priority setting calculations such as that used in the Oregon Health Care model highlight ranking the order of health categories (100 to 1) X additive impact on healthy life years, impact on suffering, population effects, vulnerable of population affected, tertiary prevention X effectiveness X need for service. Using this type of prioritization ranking results in pregnancy, pediatrics, mental health, and chronic disease management being placed at h...Competing Interests: None declared.