UNICEF New York, UNICEF House, 3 United Nations Plaza, New York, NY, 10017, USA.
King's College London GKT School of Medical Education, Guy's Campus, London, SE1 1UL, UK.
Implement Sci. 2018 Jan 25;13(1):20. doi: 10.1186/s13012-018-0712-2.
An estimated 2.6 million newborns died in 2016; over 98.5% of deaths occurred in low- and middle-income countries (LMICs). Neonates born preterm and small for gestational age are particularly at risk given the high incidence of infectious complications, cardiopulmonary, and neurodevelopmental disorders in this group. Quality improvement (QI) initiatives can reduce the burden of mortality and morbidity for hospitalised newborns in these settings. We undertook a systematic review to synthesise evidence from LMICs on QI approaches used, outcome measures employed to estimate effects, and the nature of implementation challenges.
We searched Medline, EMBASE, WHO Global Health Library, Cochrane Library, WHO ICTRP, and ClinicalTrials.gov and scanned the references of identified studies and systematic reviews. Searches covered January 2000 until April 2017. Search terms were "quality improvement", "newborns", "hospitalised", and their derivatives. Studies were excluded if they took place in high-income countries, did not include QI interventions, or did not include small and sick hospitalised newborns. Cochrane Risk of Bias tools were used to quality appraise the studies.
From 8110 results, 28 studies were included, covering 23 LMICs and 65,642 participants. Most interventions were meso level (district and clinic level); fewer were micro (patient-provider level) or macro (above district level). In-service training was the most common intervention subtype; service organisation and distribution of referencing materials were also frequently identified. The most commonly assessed outcome was mortality, followed by length of admission, sepsis rates, and infection rates. Key barriers to implementation of quality improvement initiatives included overburdened staff and lack of sufficient equipment.
The frequency of meso level, single centre, and educational interventions suggests that these interventions may be easier for programme planners to implement. The success of some interventions in reducing morbidity and mortality rates suggests that QI approaches have a high potential for benefit to newborns. Going forward, there are opportunities to strengthen the focus of QI initiatives and to develop improved, larger-scale, collaborative research into implementation of quality improvement initiatives for this high-risk group.
PROSPERO CRD42017055459 .
2016 年估计有 260 万新生儿死亡；超过 98.5%的死亡发生在中低收入国家（LMICs）。由于该组感染并发症、心肺和神经发育障碍的发生率较高，早产儿和小于胎龄儿的新生儿尤其面临风险。质量改进（QI）措施可以降低这些环境中住院新生儿的死亡率和发病率负担。我们进行了一项系统评价，综合了来自中低收入国家的关于使用的 QI 方法、用于估计效果的结果测量指标以及实施挑战性质的证据。
我们搜索了 Medline、EMBASE、世界卫生组织全球卫生图书馆、Cochrane 图书馆、世界卫生组织 ICTRP 和 ClinicalTrials.gov，并扫描了确定的研究和系统评价的参考文献。搜索范围涵盖 2000 年 1 月至 2017 年 4 月。如果研究发生在高收入国家、不包括 QI 干预措施或不包括小型和患病住院新生儿，则将其排除在外。Cochrane 风险偏倚工具用于对研究进行质量评估。
从 8110 个结果中，纳入了 28 项研究，涵盖了 23 个中低收入国家和 65642 名参与者。大多数干预措施是中尺度（区和诊所层面）；较少的是微观（患者-提供者层面）或宏观（区以上层面）。在职培训是最常见的干预亚型；服务组织和参考资料的分配也经常被确定。评估的最常见结果是死亡率，其次是住院时间、败血症发生率和感染率。实施质量改进计划的主要障碍包括人员负担过重和设备不足。
中尺度、单中心和教育干预的频率表明，这些干预措施可能更容易被方案规划者实施。一些干预措施在降低发病率和死亡率方面取得的成功表明，QI 方法对新生儿有很高的潜在益处。今后，有机会加强 QI 计划的重点，并开展更大规模、协作的研究，以实施针对这一高风险群体的质量改进计划。
PROSPERO CRD42017055459。
