“Evidence-Based Quality Improvement in Neonatal and Perinatal Medicine” is a collection of original articles commissioned by the Vermont Oxford Network. The premise of this collection is that the effectiveness and efficiency of medical care for pregnant women and newborn infants can be dramatically improved using the methods of modern quality improvement coupled with the evidence-based perspective of clinical science. Although quality improvement is being applied with increasing frequency in health care, many professionals remain skeptical of the potential benefits and there is concern that “quality improvement” is often only a code word for reducing costs. We hope that the contributions in this collection will clearly illustrate how evidence-based quality improvement has the potential to foster real and lasting improvements in neonatal and perinatal care, while pointing out the uncertainties and research opportunities that remain to be explored.
The collection is divided into three sections. Section 1 introduces the basic ideas and methods of quality improvement and evidence-based medicine in the context of neonatal and perinatal practice. It also presents the perspectives of state health departments and payers, two groups that are becoming increasingly involved in monitoring and improving the quality of perinatal care. Section 2 considers measurement issues. In a series of eight manuscripts, the sources of data regarding the outcomes and costs of perinatal and neonatal care are critically described and issues related to case-mix and risk adjustment are addressed. Section 3 includes selected examples of quality improvement approaches applied to perinatal and neonatal medicine.
This collection was created with two purposes in mind. First, it was intended to serve as a general introduction and foundation for health care professionals interested in learning about how evidence-based quality improvement and outcomes measurement can be applied in perinatal and neonatal medicine. Because thorough discussions of many of the topics are not readily available in the medical literature, original articles were commissioned for this supplement. Second, the collection of articles was designed to be used as a basic resource and reference for individuals and institutions interested in incorporating the principles of evidence-based quality improvement into their practice. One such group are the participants in the Vermont Oxford Network Evidence-Based Quality Improvement Collaborative for Neonatology (NIC/Q 2000 Project; see article by Horbar).
The authors were recruited for their expertise and experience in various aspects of Perinatal health care improvement and outcomes measurement. Each author received an honorarium from the Vermont Oxford Network to facilitate the timely submission of his or her contribution. The articles were reviewed by both of the editors, revised by the authors and then submitted as a collection to Pediatrics for further review and publication as an on-line supplement to the journal.
The editors are pleased to acknowledge the Vermont Oxford Network for sponsoring this unique collection. By supporting the publication of this supplement on the World Wide Web, “the Network hopes to promote the ideas of quality improvement within the professional community and act as a catalyst for original research in this area.”