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Alberta Collaborative Quality Improvement Strategies to Improve Outcomes of Moderate and Late Preterm Infants
Ayman Abou Mehrem1, Jennifer Toye2, Khalid Aziz2
1Department of Pediatrics (Abou Mehrem, Alshaikh, Johnson, Soraisham, Foulston, Zein, Hendson, Price, Singhal), Cumming School of Medicine and Alberta Children's Hospital Research Institute (Abou Mehrem, Benzies, Alshaikh, Johnson, Soraisham, McNeil, Hendson, Singhal), University of Calgary, Calgary, Alta.; Department of Pediatrics (Toye, Kumaran) and Office of Lifelong Learning (Aziz), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta.; Faculty of Nursing (Benzies), University of Calgary, Calgary, Alta.; Alberta Health Services (Faris, Foss, Foulston, Johns), Edmonton, Alta.; Community Health Sciences (Faris, McNeil, Zimmermann), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Alberta SPOR SUPPORT Unit (Al Hamarneh, Zimmermann); Department of Pharmacology (Al Hamarneh), Faculty of Medicine and Dentistry, University of Alberta; Covenant Health (Foss), Edmonton, Alta.; Department of Pediatrics (Shah), Mount Sinai Hospital; Department of Pediatrics (Shah), University of Toronto, Toronto, Ont. a.aboumehrem@ucalgary.ca.
Insights
The Alberta Collaborative Quality Improvement Strategies to Improve Outcomes of Moderate and Late Preterm Infants (ABC-QI) Trial investigates if Evidence-based Practice for Improving Quality (EPIQ) strategies reduce hospital stays for preterm infants. This trial aims to improve care for moderate and late preterm neonates.
Area of Science:
- Neonatal intensive care
- Quality improvement science
- Pediatric health outcomes
Background:
- Evidence-based Practice for Improving Quality (EPIQ) has improved outcomes for very preterm infants.
- The Alberta Collaborative Quality Improvement Strategies to Improve Outcomes of Moderate and Late Preterm Infants (ABC-QI) Trial will evaluate EPIQ in moderate and late preterm neonates.
- This study focuses on improving care for preterm infants born between 32 and 36 weeks' gestation.
Purpose of the Study:
- To assess the impact of EPIQ collaborative quality improvement strategies on moderate and late preterm neonates in Alberta.
- To evaluate the effect of EPIQ on length of hospital stay, healthcare costs, and short-term clinical outcomes.
- To provide population-based data for future research, benchmarking, and quality improvement initiatives.
Main Methods:
- A 4-year, multicentre, stepped-wedge cluster randomized trial involving 12 neonatal intensive care units (NICUs).
- Intervention includes respiratory and nutritional care bundles implemented using EPIQ strategies.
- Data collection includes baseline practices, transition to intervention, and follow-up assessments of clinical outcomes and quality improvement culture.
Main Results:
- Primary outcome is length of hospital stay.
- Secondary outcomes include healthcare costs and short-term clinical outcomes.
- Quality improvement culture will be assessed via surveys and interviews.
Conclusions:
- The ABC-QI Trial will determine if collaborative quality improvement strategies impact length of stay in moderate and late preterm neonates.
- Findings will inform quality improvement efforts and resource allocation in neonatal care.
- The study will generate valuable data for advancing the care of preterm infants.
Background:
Evidence-based Practice for Improving Quality (EPIQ) is a collaborative quality improvement method adopted by the Canadian Neonatal Network that led to decreased mortality and morbidity in very preterm neonates. The Alberta Collaborative Quality Improvement Strategies to Improve Outcomes of Moderate and Late Preterm Infants (ABC-QI) Trial aims to evaluate the impact of EPIQ collaborative quality improvement strategies in moderate and late preterm neonates in Alberta, Canada.
Methods:
In a 4-year, multicentre, stepped-wedge cluster randomized trial involving 12 neonatal intensive care units (NICUs), we will collect baseline data with the current practices in the first year (all NICUs in the control arm). Four NICUs will transition to the intervention arm at the end of each year, with 1 year of follow-up after the last group transitions to the intervention arm. Neonates born at 32 + 0 to 36 + 6 weeks' gestation with primary admission to NICUs or postpartum units will be included. The intervention includes implementation of respiratory and nutritional care bundles using EPIQ strategies, including quality improvement team building, quality improvement education, bundle implementation, quality improvement mentoring and collaborative networking. The primary outcome is length of hospital stay; secondary outcomes include health care costs and short-term clinical outcomes. Neonatal intensive care unit staff will complete a survey in the first year to assess quality improvement culture in each unit, and a sample will be interviewed 1 year after implementation in each unit to evaluate the implementation process.
Interpretation:
The ABC-QI Trial will assess whether collaborative quality improvement strategies affect length of stay in moderate and late preterm neonates. It will provide detailed population-based data to support future research, benchmarking and quality improvement.
Trial Registration:
ClinicalTrials.gov, no. NCT05231200.
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