解决新生儿阿片类药物戒断综合征医疗利用的驱动因素。
Addressing drivers of healthcare utilization for neonatal opioid withdrawal syndrome.
机构信息
University of California Los Angeles Geffen School of Medicine, Los Angeles, CA, USA.
Hofstra Northwell Zucker School of Medicine, Uniondale, NY, USA.
出版信息
J Perinatol. 2023 Mar;43(3):392-401. doi: 10.1038/s41372-022-01533-z. Epub 2022 Oct 6.
OBJECTIVE
Aim to reduce healthcare utilization (HU) for infants at risk of neonatal opioid withdrawal syndrome (NOWS) by 30% in 1 year and sustain for 2 years.
STUDY DESIGN
Baseline data from three Level I & II newborn nurseries from January 2016 to June 2018 informed PDSA cycles from August 2018 to December 2021. Shewhart process control charts evaluated length of stay (LOS), pharmacologic treatment (PT) rates, direct cost (DC), process, and balancing measures for special cause variation (SCV).
RESULTS
Two hundred and seventeen infants showed downward SCV in LOS (12.6 to 4.4 days), PT (53% to 17%) and DC ($12593.82 to $5219.17). Onset of the COVID-19 pandemic coincided with reversible SCV. DC varied by provider specialty.
CONCLUSION
Transition from MFNASS to ESC led to decrease in healthcare utilization for infants at risk of NOWS. QI methodology identified persistent drivers of variability, including the COVID-19 pandemic and provider specialty.
目的
在 1 年内将患有新生儿阿片类戒断综合征（NOWS）风险的婴儿的医疗保健利用率（HU）降低 30%，并持续 2 年。
研究设计
从 2016 年 1 月至 2018 年 6 月的三个 I 级和 II 级新生儿病房的基线数据，为 2018 年 8 月至 2021 年 12 月的 PDSA 循环提供了信息。Shewhart 过程控制图评估了住院时间（LOS）、药物治疗（PT）率、直接成本（DC）、过程和特殊原因变化（SCV）的平衡措施。
结果
217 名婴儿的 LOS（12.6 至 4.4 天）、PT（53%至 17%）和 DC（$12593.82 至 $5219.17）呈下降性 SCV。COVID-19 大流行的开始与可逆转的 SCV 相吻合。DC 因提供者的专业而异。
结论
从 MFNASS 过渡到 ESC 导致患有 NOWS 风险的婴儿的医疗保健利用率降低。质量改进方法确定了持续存在的变异性驱动因素，包括 COVID-19 大流行和提供者的专业。
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