Collaborative quality improvement to promote evidence based surfactant for preterm infants: a cluster randomised trial
Collaborative quality improvement to promote evidence based surfactant for preterm infants: a cluster randomised trial
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DOI：
10.1136/bmj.329.7473.1004
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发表时间：
2004-10-30
影响因子：
105.7
通讯作者：
Sinclair, JC
中科院分区：
文献类型：
--
作者：
Horbar, JD;Carpenter, JH;Sinclair, JC
目的探讨一种旨在促进基于证据的表面活性剂治疗23-29周早产儿的多层面协同质量改善干预方法。设计聚类随机对照试验。114个新生儿重症监护病房（治疗了2001年出生的6039名妊娠23-29周的婴儿）。护理措施过程：在产房接受第一次表面活性剂的婴儿比例、出生后2小时以上接受第一次表面活性剂的婴儿比例、从出生到第一次表面活性剂的中位时间。临床结果：出院前死亡，气胸。干预措施多方面的协作质量改进建议，包括审计和反馈，证据审查，互动培训研讨会，以及通过电话会议和电子邮件进行的教师支持。结果与对照医院相比，干预医院的婴儿在产房接受表面活性剂的可能性更高（校正优势比5.38(95%可信区间2.84 ~ 10.20)），出生后2小时以上接受首次剂量的可能性更低（校正优势比0.35(0.24 ~ 0.53)），出生后较早接受首次剂量(中位数为21分钟vs 78分钟，P
Objective To test a multifaceted collaborative quality improvement intervention designed to promote evidence based surfactant treatment for preterm infants of 23-29 weeks' gestation.Design Cluster randomised controlled trial.Setting and participants 114 neonatal intensive care units (which treated 6039 infants of 23-29 weeks gestation born in 2001).Main outcome measures Process of care measures: proportion of infants receiving first surfactant in the delivery room, proportion receiving first surfactant more than two hours after birth, and median time from birth to first dose of surfactant. Clinical outcomes: death before discharge home, and pneumothorax.Intervention Multifaceted collaborative quality improvement advice including audit and feedback, evidence reviews, an interactive training workshop, and ongoing faculty support via conference calls and email.Results Compared with those in control hospitals, infants in intervention hospitals were more likely to receive surfactant in the delivery room (adjusted odds ratio 5.38 (95% confidence interval 2.84 to 10.20)), were less likely to receive the first dose more than two hours after birth (adjusted odds ratio 0.35 (0.24 to 0.53)), and received the first dose of surfactant sooner after birth (median of 21 minutes v 78 minutes, P