PHYSICIAN PARTICIPATION IN QUALITY MANAGEMENT - USING HEALTH-CARE OUTCOMES TO IMPROVE PATIENT-CARE IN THE NICU

Background: The Kaiser Permanente Medical Care Program, Southern California Region, implemented an outcomes-based research program within its neonatal intensive care units. Method. The primary objective of the Kaiser outcomes monitoring project was to provide a mechanism for identifying optimal care processes that can lead to reduced morbidity, mortality, and resource use in caring for infants, with low birth weights. Comparisons with one benchmark study resulted in physician practice pattern changes in the areas of discharge planning. For example, multidisciplinary discharge-planning rounds were initiated, infants who would need home monitors or oxygen delivery devices were identified early in the care continuum, and parents received timely training in infant cardiopulmonary resuscitation. An analysis of nutritional practices within the Kaiser neonatal intensive care units (NICUs) resulted in the reduction of nosocomial infection rates and improvements in infant weight gains. Modification of ventilation practices reduced a high rate of severe intracranial hemorrhage in another NICU. Analysis is ongoing on the causes of lengthier durations of ventilation at one Kaiser NICU. Conclusion: A recent survey of NICUs revealed that 80% of respondents were capable of performing their own outcomes research. The authors suggest that a national organization be formed to assist NICUs in the abstracting, collecting, and comparing of NICU data to study areas of interest.