Lee Shoo K, Aziz Khalid, Singhal Nalini, Cronin Catherine M, James Andrew, Lee David S C, Matthew Derek, Ohlsson Arne, Sankaran Koravangattu, Seshia Mary, Synnes Anne, Walker Robin, Whyte Robin, Langley Joanne, MacNab Ying C, Stevens Bonnie, von Dadelszen Peter
Departments of Paediatrics, University of Toronto, Toronto, Ontario, Canada.
CMAJ. 2009 Oct 13;181(8):469-76. doi: 10.1503/cmaj.081727. Epub 2009 Aug 10.
We developed and tested a new method, called the Evidence-based Practice for Improving Quality method, for continuous quality improvement.
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.
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.
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.
我们开发并测试了一种名为“基于证据的质量改进实践”的新方法，用于持续质量改进。
我们采用整群随机化方法，将6个新生儿重症监护病房（ICU）分配至降低医院感染组（感染组），另外6个ICU分配至降低支气管肺发育不良组（肺部组）。纳入所有孕周为32周及以下的出生婴儿。我们收集了1年的基线数据。采用快速变化周期实施实践改变干预措施，为期2年。
感染组和肺部组ICU之间医院感染的发病率趋势差异（趋势线斜率）为-0.0020（95%置信区间[CI]-0.0007至0.0004），支气管肺发育不良的发病率趋势差异为-0.0006（95%CI-0.0011至-0.0001）。
结果表明，“基于证据的质量改进实践”方法降低了新生儿ICU中的支气管肺发育不良，并且可能降低医院感染。
