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[A quality improvement study on improving the follow-up rate of preterm infants after discharge]
He-Sheng Chang1, Xue Yang1, Jun Ju1
1Department of Pediatrics, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College/State Key Laboratory of Complex Severe and Rare Diseases Beijing 100730 China.
Insights
Quality improvement methods significantly increased preterm infant follow-up rates post-discharge, addressing key failures in management and communication. This approach is effective for improving infant care outcomes.
Area of Science:
- Neonatal care
- Public health
- Healthcare quality improvement
Context:
- Preterm infants require consistent follow-up post-discharge to ensure optimal health outcomes.
- Baseline follow-up rates were suboptimal, necessitating targeted interventions.
- The COVID-19 pandemic highlighted the vulnerability of established follow-up systems.
Purpose:
- To implement and evaluate quality improvement measures to enhance the follow-up rate of preterm infants.
- To identify and address the primary barriers to successful infant follow-up.
- To establish a sustainable system for monitoring and improving follow-up adherence.
Summary:
- A quality improvement initiative analyzed baseline data (57.92% follow-up rate) using Pareto charts to identify key failure points: file management, irregular timing, inadequate education, and unmet parental needs.
- Interventions included enhanced education, a dedicated follow-up team, and a new platform/system.
- The strategy successfully increased follow-up rates to 83.09% by December 2017, surpassing the 80% goal, and demonstrated resilience post-pandemic.
Impact:
- Successfully improved the critical follow-up rate for preterm infants, enhancing long-term health prospects.
- Demonstrated the feasibility and practicality of quality improvement methodologies in clinical settings.
- Provides a scalable model for other healthcare settings to improve post-discharge care for vulnerable infant populations.
Objectives:
To explore the measures to improve the follow-up rate of preterm infants after discharge, and to evaluate the effectiveness of these measures using quality improvement methodology.
Methods:
The follow-up status of preterm infants discharged from March to May 2017 was used as the baseline before quality improvement, and a specific quality improvement goal for the follow-up rate was proposed. The Pareto chart was used to analyze the causes of follow-up failure, and a key driver diagram was constructed based on the links involved in improving follow-up rate. The causes of failure were analyzed to determine the key links and intervention measures for quality improvement, and the follow-up rate was monitored weekly using a control chart until the quality improvement goal was achieved.
Results:
The follow-up rate of preterm infants after discharge was 57.92% (117/202) at baseline before quality improvement, and the quality improvement goal was set to increase the follow-up rate of preterm infants from baseline to more than 80% within 12 months. The Pareto chart analysis showed that the main causes of follow-up failure were deficiencies in follow-up file management and irregular follow-up times (33.70%, 31/92), insufficient follow-up education and poor communication (25.00%, 23/92), and the inability to meet the diverse needs of parents (18.48%, 17/92). Based on the key links for quality improvement and the main causes of follow-up failure, the following intervention measures were adopted: (1) strengthen follow-up publicity and education; (2) build a follow-up team; and (3) establish a follow-up platform and system. The control chart indicated that with the implementation of the above intervention measures, the weekly follow-up rate increased to 74.09% (306/413) in July 2017 and 83.09% (511/615) in December 2017, finally achieving the quality improvement goal. During the COVID-19 pandemic, the follow-up rate of preterm infants fluctuated between 23.54% (460/1 954) and 70.97% (1 931/2 721), and subsequently, it returned to pre-pandemic levels starting in February 2023.
Conclusions:
The application of quality improvement methodology can help to formulate intervention measures based on the main causes of follow-up failure, thereby improving the follow-up rate of preterm infants after discharge. This quality improvement method is feasible and practical and thus holds promise for clinical application.
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