Massachusetts Multisite Quality Improvement to Address Family Engagement in Level 2-3 Neonatal Intensive Care Units

Area of Science:

• Neonatal care quality improvement
• Family-centered care initiatives
• Health disparities in NICU settings

Background:

• Family engagement is crucial in neonatal intensive care units (NICUs), yet multisite quality improvement efforts with robust metrics are limited.
• Previous efforts often lacked focus on reducing disparities by maternal race/ethnicity or preferred language.

Purpose of the Study:

• To increase specific measures of NICU family engagement by at least 20% within two years.
• To ensure improvements occurred without disparities based on maternal race/ethnicity or preferred language.
• To implement and test interventions in Massachusetts NICUs.

Main Methods:

• Utilized an Institute for Healthcare Improvement Breakthrough Series framework for multisite quality improvement.
• Collected data on 459 infants admitted for 14 days or more between January 2021 and December 2022.
• Analyzed family engagement measure rates quarterly using run charts and compared rates by maternal demographics using chi-squared tests.

Main Results:

• Conducted 47 plan-do-study-act cycles, leading to significant increases in discharge skills training (57% to 90%) and unmet basic needs assessment (39% to 96%).
• Observed that many implemented drivers were more frequent for infants of non-White and non-English-speaking mothers.
• Pilot data collection on parent-reported measures was performed.

Conclusions:

• Massachusetts NICUs successfully implemented interventions to enhance family engagement.
• The developed and tested chart-abstracted and family-reported measures for family engagement are potentially generalizable to other NICUs.
• The study highlights the importance of addressing disparities in family engagement initiatives.