Department of Pediatrics (Neonatology), Kaiser Permanente Panorama City, Panorama City, California.
Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena.
JAMA Netw Open. 2021 Jun 1;4(6):e2114140. doi: 10.1001/jamanetworkopen.2021.14140.
Bronchopulmonary dysplasia (BPD) rates in the United States remain high and have changed little in the last decade.
To develop a consistent BPD prevention bundle in a systematic approach to decrease BPD.
DESIGN, SETTING, AND PARTICIPANTS: This quality improvement study included 484 infants with birth weights from 501 to 1500 g admitted to a level 3 neonatal intensive care unit in the Kaiser Permanente Southern California system from 2009 through 2019. The study period was divided into 3 periods: 1, baseline (2009); 2, initial changes based on ongoing cycles of Plan-Do-Study-Act (2010-2014); and 3, full implementation of successive Plan-Do-Study-Act results (2015-2019).
A BPD prevention system of care bundle evolved with a shared mental model that BPD is avoidable.
The primary outcome was BPD in infants with less than 33 weeks' gestational age (hereafter referred to as BPD <33). Other measures included adjusted BPD <33, BPD severity grade, and adjusted median postmenstrual age (PMA) at hospital discharge. Balancing measures were adjusted mortality and adjusted mortality or specified morbidities.
The study population included 484 infants with a mean (SD) birth weight of 1070 (277) g; a mean (SD) gestational age of 28.6 (2.9) weeks; 252 female infants (52.1%); and 61 Black infants (12.6%). During the 3 study periods, BPD <33 decreased from 9 of 29 patients (31.0%) to 3 of 184 patients (1.6%) (P < .001 for trend); special cause variation was observed. The standardized morbidity ratio for the adjusted BPD <33 decreased from 1.2 (95% CI, 0.7-1.9) in 2009 to 0.4 (95% CI, 0.2-0.8) in 2019. The rates of combined grades 1, 2, and 3 BPD decreased from 7 of 29 patients (24.1%) to 17 of 183 patients (9.3%) (P < .008 for trend). Grade 2 BPD rates decreased from 3 of 29 patients (10.3%) to 5 of 183 patients (2.7%) (P = .02 for trend). Adjusted median PMA at home discharge decreased by 2 weeks, from 38.2 (95% CI, 37.3-39.1) weeks in 2009 to 36.8 (95% CI, 36.6-37.1) weeks during the last 3 years (2017-2019) of the full implementation period. Adjusted mortality was unchanged, whereas adjusted mortality or specified morbidities decreased significantly.
A sustained low rate of BPD was observed in infants after the implementation of a detailed BPD system of care.
美国的支气管肺发育不良（BPD）发生率仍然很高，在过去十年中几乎没有变化。
通过系统的方法制定一致的 BPD 预防方案，以降低 BPD 的发生率。
设计、地点和参与者：本质量改进研究纳入了 2009 年至 2019 年期间在凯撒永久南加州系统的三级新生儿重症监护病房住院的体重为 501 至 1500 克的 484 名婴儿。研究期间分为 3 个阶段：1. 基线（2009 年）；2. 基于持续的计划-执行-研究-行动循环的初始变化（2010-2014 年）；3. 连续的计划-执行-研究-行动结果的全面实施（2015-2019 年）。
BPD 预防护理系统的演变伴随着一个共同的心理模型，即 BPD 是可以避免的。
主要结果是胎龄小于 33 周（以下简称胎龄 <33）的婴儿的 BPD。其他措施包括调整后的胎龄 <33、BPD 严重程度等级和调整后的出院时中位校正孕周（PMA）。平衡措施包括调整后的死亡率和调整后的死亡率或特定的发病率。
研究人群包括 484 名婴儿，平均（SD）出生体重为 1070（277）克；平均（SD）胎龄为 28.6（2.9）周；252 名女婴（52.1%）和 61 名黑人婴儿（12.6%）。在 3 个研究期间，胎龄 <33 的 BPD 从 29 名患者中的 9 名（31.0%）降至 184 名患者中的 3 名（1.6%）（趋势 P <.001）；观察到特殊原因的变异。调整后的胎龄 <33 的标准化发病率从 2009 年的 1.2（95%CI，0.7-1.9）降至 2019 年的 0.4（95%CI，0.2-0.8）。1、2、3 级合并 BPD 的发生率从 29 名患者中的 7 名（24.1%）降至 183 名患者中的 17 名（9.3%）（趋势 P <.008）。2 级 BPD 的发生率从 29 名患者中的 3 名（10.3%）降至 183 名患者中的 5 名（2.7%）（趋势 P =.02）。调整后的中位出院时 PMA 下降了 2 周，从 2009 年的 38.2（95%CI，37.3-39.1）周降至最后 3 年（2017-2019 年）的 36.8（95%CI，36.6-37.1）周。调整后的死亡率保持不变，而调整后的死亡率或特定的发病率显著下降。
在实施详细的 BPD 护理系统后，观察到婴儿的 BPD 发生率持续较低。
