Published online May 1, 2007
PEDIATRICS Vol. 119 No. 5 May 2007, pp. 876-890 (doi:10.1542/peds.2006-2656)
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ARTICLE

A Cluster-Randomized Trial of Benchmarking and Multimodal Quality Improvement to Improve Rates of Survival Free of Bronchopulmonary Dysplasia for Infants With Birth Weights of Less Than 1250 Grams

Michele Walsh, MD, MSa, Abbott Laptook, MDb, S. Nadya Kazzi, MD, MPHc, William A. Engle, MDd, Qing Yao, PhDe, Maynard Rasmussen, MDf, Susie Buchter, MDg, Gregory Heldt, MDh, William Rhine, MDi, Rose Higgins, MDj, Kenneth Poole, PhDe for the National Institute of Child Health and Human Development Neonatal Research Network

a Department of Pediatrics, Rainbow Babies & Children's Hospital, Case Western Reserve University, Cleveland, Ohio
b Department of Pediatrics, Women & Infants Hospital, Brown University, Providence, Rhode Island
c Department of Pediatrics, Wayne State University, Detroit, Michigan
d Department of Pediatrics, Riley Hospital for Children, Indiana University, Indianapolis, Indiana
e Research Triangle Institute, Research Triangle Park, North Carolina
f Department of Pediatrics, Sharp Mary Birch Hospital, University of California, San Diego, San Diego, California
g Department of Pediatrics, Emory University, Atlanta, Georgia
h Department of Pediatrics, University of California, San Diego, San Diego, California
i Department of Pediatrics, Lucille Packard Children's Hospital, Stanford University, Palo Alto, California
j National Institute of Child Health and Human Development, Rockville, Maryland

OBJECTIVE. We tested whether NICU teams trained in benchmarking and quality improvement would change practices and improve rates of survival without bronchopulmonary dysplasia in inborn neonates with birth weights of <1250 g.

METHODS. A cluster-randomized trial enrolled 4093 inborn neonates with birth weights of <1250 g at 17 centers of the National Institute of Child Health and Human Development Neonatal Research Network. Three centers were selected as best performers, and the remaining 14 centers were randomized to intervention or control. Changes in rates of survival free of bronchopulmonary dysplasia were compared between study year 1 and year 3.

RESULTS. Intervention centers implemented potentially better practices successfully; changes included reduced oxygen saturation targets and reduced exposure to mechanical ventilation. Five of 7 intervention centers and 2 of 7 control centers implemented use of high-saturation alarms to reduce oxygen exposure. Lower oxygen saturation targets reduced oxygen levels in the first week of life. Despite these changes, rates of survival free of bronchopulmonary dysplasia were all similar between intervention and control groups and remained significantly less than the rate achieved in the best-performing centers (73.3%).

CONCLUSIONS. In this cluster-randomized trial, benchmarking and multimodal quality improvement changed practices but did not reduce bronchopulmonary dysplasia rates.

Key Words: quality improvement • randomized trial • bronchopulmonary dysplasia

Abbreviations: QI—quality improvement • BPD—bronchopulmonary dysplasia • PMA—postmenstrual age • CPAP—continuous positive airway pressure • OR—odds ratio • CI—confidence interval

Accepted Dec 27, 2006.