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: 6588767
• 负责人: R H PALMER
• 金额: $ 12.95万
• 依托单位: HARVARD SCHOOL OF PUBLIC HEALTH
• 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/6588767
• 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.

该项目将开发和评估一个合作模式， 结构松散的管理式护理的质量改进计划 组织（MCO）。 大多数质量改进举措， 医院或MCO发生在严格管理的系统中。 该模型 阐述了MCO如何履行其质量责任 专业人员和与他们有联系的组织之间的改善 合同杠杆，但不是直接控制。 该模型将被测试 通过向美国儿科临床实践学会申请 健康足月新生儿黄疸护理指南。 两家大型管理式医疗机构将与核心研究合作 团队，招募特定的病人护理单位-组织和 负责婴儿护理的专业人员， 生命的第一个月-参与。MCO将进行和 评估两轮协作QI，每轮侧重于不同的 对质量的看法。 首先，MCO将专注于改善 从专业角度看临床表现。 在第二种情况下， 重点将是改善父母接受照顾的经验， 为了他们的新生儿。 临床与消费者的关系 将探索各种观点，以检验临床上是否具有良好的 供应商或多或少成功地提供了高质量的 患者体验 临床性能将通过测量符合性进行评估 针对血清水平升高的婴儿的指南推荐 胆红素水平 临床性能测量数据将 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， 婴儿门诊病历。 父母的照顾经验 将通过对家长的电话调查进行评估， 改编自AHCPR的消费者健康计划评估调查 （CAHPS）适用于婴儿的第一个月的生活和护理 黄疸预计约有2，200名符合研究条件的婴儿 在两个参与的MCO中。 父母的经验和临床表现数据将反馈给 MCO每季度一次，以激励和指导QI工作。 每个 MCO将与另一方合作交换性能数据， 病人护理的最佳实践，以及质量改进的想法。 他们还将在实施额外的MCO特定QI方面获得帮助 干预措施。 五年效果总体总结性评价 将开展协作QI计划。 此外，临床和 与同一婴儿有关的父母经验数据将被配对， 绩效的趋同性和差异性分析 病人护理单位。 最后，对业绩计量的说明 基于临床性能和母公司经验数据，以及 样本结果，将用于引起独立的评估， 购买者、消费者和医生组成的小组， 这两种措施。

项目成果

Barriers to first-week follow-up of newborns: findings from parent and clinician focus groups.

新生儿第一周随访的障碍：家长和临床医生焦点小组的发现。

• DOI: 10.1016/s1549-3741(04)30070-5
• 发表时间: 2004
• 期刊: Joint Commission journal on quality and safety
• 作者: Salem-Schatz,Susanne;Peterson,LauraE;Palmer,RHeather;Clanton,SMMark;Ezhuthachan,Sudhakar;Luttrell,RichardC;Newman,Chris;Westbury,Roinell
• 通讯作者: Westbury,Roinell

National Institute of Child Health and Human Development (NICHD) conference on kernicterus: a population perspective on prevention of kernicterus.

国家儿童健康和人类发展研究所 (NICHD) 关于核黄疸的会议：预防核黄疸的人口观点。

• DOI: 10.1038/sj.jp.7211153
• 发表时间: 2004
• 期刊: Journal of perinatology : official journal of the California Perinatal Association.
• 作者: Palmer,RHeather;Keren,Ron;Maisels,MJeffrey;Yeargin-Allsopp,Marshalyn
• 通讯作者: Yeargin-Allsopp,Marshalyn

Breastfeeding advice given to African American and white women by physicians and WIC counselors.

医生和 WIC 顾问向非裔美国和白人女性提供母乳喂养建议。

• DOI: 10.1093/phr/118.4.368
• 发表时间: 2003
• 期刊: Public health reports (Washington, D.C. : 1974)
• 作者: Beal,AnneC;Kuhlthau,Karen;Perrin,JamesM
• 通讯作者: Perrin,JamesM