Formal selection of measures for a composite index of NICU quality of care: Baby-MONITOR

Section of Neonatology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA.
Journal of perinatology: official journal of the California Perinatal Association (Impact Factor: 2.07). 02/2011; 31(11):702-10. DOI: 10.1038/jp.2011.12
Source: PubMed


To systematically rate measures of care quality for very low birth weight infants for inclusion into Baby-MONITOR, a composite indicator of quality.
Modified Delphi expert panelist process including electronic surveys and telephone conferences. Panelists considered 28 standard neonatal intensive care unit (NICU) quality measures and rated each on a 9-point scale taking into account pre-defined measure characteristics. In addition, panelists grouped measures into six domains of quality. We selected measures by testing for rater agreement using an accepted method.
Of 28 measures considered, 13 had median ratings in the high range (7 to 9). Of these, 9 met the criteria for inclusion in the composite: antenatal steroids (median (interquartile range)) 9(0), timely retinopathy of prematurity exam 9(0), late onset sepsis 9(1), hypothermia on admission 8(1), pneumothorax 8(2), growth velocity 8(2), oxygen at 36 weeks postmenstrual age 7(2), any human milk feeding at discharge 7(2) and in-hospital mortality 7(2). Among the measures selected for the composite, the domains of quality most frequently represented included effectiveness (40%) and safety (30%).
A panel of experts selected 9 of 28 routinely reported quality measures for inclusion in a composite indicator. Panelists also set an agenda for future research to close knowledge gaps for quality measures not selected for the Baby-MONITOR.

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Available from: John Zupancic, Mar 30, 2014
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    • "The variables used for the benchmarking and quality indicator calculations were chosen because of their capacity to describe clinically important and/or modifiable processes and outcome [11]. Many of them also appear in the Baby-MONITOR, a composite indicator for quality recently published by Profit et al. (2011) that both an expert panel as well as practicing clinicians agreed upon as having high face validity [19,20]: prenatal steroids, late onset sepsis, oxygen at 36 weeks postmenstrual age, growth velocity and in-hospital mortality. However, in order to complete Profit et al.’s choice of measures included into the Baby-MONITOR, the network would need to add timely ROP exam, pneumothorax, human milk feeding at discharge and hypothermia on admission. "
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