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Measuring quality of care in moderate and late preterm infants
Elizabeth G Salazar1,2, Sara C Handley3,4,5, Lucy T Greenberg6,7
1Division of Neonatology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA. salazare@chop.edu.
Insights
Quality measures for moderate and late preterm (MLP) infants showed weak correlations with those for extremely preterm infants. This suggests a need for specific quality measures tailored to MLP infant care.
Area of Science:
- Neonatalogy
- Pediatric Quality Improvement
- Perinatal Health
Background:
- Moderate and late preterm (MLP) infants (30-36 weeks gestational age) represent a significant population within Neonatal Intensive Care Units (NICUs).
- Existing quality measures, such as Baby-MONITOR, have been developed for extremely/very preterm infants (25-29 weeks gestational age).
- The applicability of these existing measures to the MLP population requires examination.
Purpose of the Study:
- To adapt and evaluate a composite quality measure for moderate and late preterm (MLP) infants.
- To examine the correlation between an adapted MLP quality measure (MLP-QM) and the Baby-MONITOR measure in extremely/very preterm infants.
Main Methods:
- Prospective analysis of the Vermont Oxford Network's NICU admissions database.
- Adaptation of the Baby-MONITOR composite quality measure for MLP infants, termed MLP-QM.
- Correlation analysis between MLP-QM scores in MLP infants and Baby-MONITOR scores in extremely/very preterm infants.
Main Results:
- Analysis included 376,219 MLP infants and 57,595 extremely/very preterm infants from 465 U.S. hospitals (2016-2020).
- Overall MLP-QM scores showed weak correlation with Baby-MONITOR scores (r=0.47).
- Strong correlations were observed for human milk at discharge (r=0.79) and absence of hypothermia (r=0.76), while survival and absence of pneumothorax/infection showed weaker correlations.
Conclusions:
- The modest correlation across various hospital care measures indicates that existing quality metrics may not fully capture the nuances of MLP infant care.
- Development and implementation of MLP-specific quality measures are recommended to optimize care for this population.
Objective:
To examine quality measures for moderate and late preterm (MLP) infants.
Study Design:
By prospectively analyzing Vermont Oxford Network's all NICU admissions database, we adapted Baby-MONITOR, a composite quality measure for extremely/very preterm infants, for MLP infants. We examined correlations between the adapted MLP quality measure (MLP-QM) in MLP infants and Baby-MONITOR in extremely and very preterm infants.
Result:
We studied 376,219 MLP (30-36 weeks GA) and 57,595 extremely/very preterm (25-29 weeks GA) infants from 465 U.S. hospitals born from 2016 to 2020. MLP-QM summary scores in MLP infants had weak correlation with Baby-MONITOR scores in extremely and very preterm infants (r = 0.47). There was weak correlation among survival (r = 0.19), no pneumothorax (r = 0.35), and no infection after 3 days (r = 0.45), but strong correlation among human milk at discharge (r = 0.79) and no hypothermia (r = 0.76).
Conclusion:
Modest correlation among hospital care measures in two preterm populations suggests the need for MLP-specific care measures.
