MAJIC, MAKING ADVANCES AGAINST JAUNDICE IN INFANT CARE

该项目将开发和评估合作伙伴的模型 松散结构管理型医疗的质量改进计划 组织(MCO)。大多数质量改进计划适用于 医院或MCO发生在严格管理的系统中。这款车 阐述MCO如何履行其质量责任 改善与他们有合作关系的专业人员和组织 契约杠杆，但不是直接控制。该模型将进行测试 申请美国儿科学会临床实践 健康足月黄褐症新生儿护理指南。 两家大型管理型医疗机构将与核心研究合作 团队，招募特定的患者护理单位-组织和 负责持续照顾婴儿的专业人员 生命的第一个月--参与。MCOS将进行和 评估两轮协作性QI，每一轮都侧重于不同的 关于质量的观点。首先，MCO将专注于改进 从专业角度看临床表现。在第二个阶段， 重点将是改善父母接受护理的体验 为了他们的新生儿。临床与消费者的关系 将探索前景，以测试临床上是否优秀 供应商或多或少成功地提供了高质量的 耐心体验。 临床表现将通过测量符合情况进行评估 对血清升高的婴儿的部分指南建议 胆红素水平。临床性能测量的数据将是 从行政来源(索赔、遭遇和实验室)获得 数据库)，婴儿的住院病历，如有必要， 婴儿的动态医疗记录。父母关爱的体验 将通过对父母的电话调查进行评估，并提出问题 改编自AHCPR的健康计划消费者评估调查 (Cahps)适用于婴儿生命和护理的第一个月 黄褐症。预计将有大约2200名符合研究条件的婴儿 两名参赛的司令官。 父母的经验和临床表现数据将反馈给 MCO每季度激励和指导QI工作。每个人 MCO将与另一方合作交换性能数据， 病人护理和质量改进想法的最佳实践。 他们还将在实施额外的特定于MCO的QI方面得到帮助 干预措施。 对五年工作成效的全面总结性评价 将实施协作式QI计划。此外，临床和 与同一婴儿有关的父母体验数据将配对 两种算法性能之间的趋同与发散分析 病人护理病房。最后，对绩效衡量标准的描述 基于临床表现和家长经验数据，以及 样本结果，将被用来引发独立的评估 由购买者、消费者和医生组成的小组讨论 这两类措施。

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.