MAJIC, MAKING ADVANCES AGAINST JAUNDICE IN INFANT CARE

MAJIC，在婴儿护理领域对抗黄疸取得进展

• 批准号: 2892894
• 负责人: R H PALMER
• 金额: $ 1.27万
• 依托单位: HARVARD MEDICAL SCHOOL
• 依托单位国家: 美国
• 财政年份: 1998
• 资助国家: 美国
• 起止时间: 1998-05-01 至 2003-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/2892894
• 关键词: behavioral /social science research tag; bilirubin; clinical research; decision making; health care personnel performance; health care quality; health care service evaluation; health insurance; health services research tag; health surveys; home health care; hospital length of stay; human subject; hyperbilirubinemia; interview; maternal behavior; model design /development; neonatal transient jaundice; newborn human (0-6 weeks); parents; paternal behavior; physicians

This project will develop and evaluate a model for a Collaborative Quality Improvement Program in loosely structured managed care organizations (MCOs). Most quality improvement initiatives for hospitals or MCOs have occurred in tightly managed systems. This model addresses how MCOs can fulfill their responsibility for quality improvement among professionals and organizations with whom they have contractual leverage but not direct control. The model will be tested by application to the American Academy of Pediatrics clinical practice guideline for the care of the healthy term newborn with jaundice. Two large managed care organizations will partner with the core research team, enlisting specific patient care units - organizations and professionals responsible for the continuum of care for a baby during the first month of life - to participate. The MCOs will conduct and evaluate two rounds of collaborative QI, each focusing on a distinct perspective on quality. In the first, the MCO will focus on improving clinical performance from the professional perspective. In the second, the focus will be improving the parents experience of receiving care for their newborn. The relationship between clinical and consumer perspectives will be explored to test whether clinically excellent providers are more or less successful in providing a high quality patient experience. Clinical performance will be assessed by measuring conformance with selected guideline recommendations for infants with an elevated serum bilirubin level. Data for clinical performance measurement will be obtained from administrative sources (claims, encounter and laboratory databases), the infant's inpatient medical record and if necessary the infant's ambulatory medical record. The parental experience of care will be assessed by a telephone survey of parents, with questions adapted from the AHCPR's Consumer Assessment of Health Plans Survey (CAHPS) to apply to the baby's first month of life and care for jaundice. Approximately 2,200 study-eligible infants are anticipated across the two participating MCOs. Parental experience and clinical performance data will be fed back to the MCOs on a quarterly basis to stimulate and guide QI efforts. Each MCO will collaborate with the other on exchange of performance data, of best practices for patient care, and of quality improvement ideas. They will also be aided in implementing additional, MCO-specific QI interventions. An overall summative evaluation of the effect of the five-year Collaborative QI Program will be conducted. In addition, clinical and parent experience data relating to the same baby will be paired for analyses of the convergence and divergence between the performance of patient care units. Finally, descriptions of the performance measures based on clinical performance and parent experie nce data, together with sample results, will be used to elicit an evaluation by independent panels of purchasers, consumers and physicians of the usefulness of these two types of measures.

这个项目将开发和评估一个协作的模型