BookJoseph Schulman, editor.
Summary: Neonatal intensive care unit (NICU) teams in the US and around the world receive performance reports that locate their particular value for selected process and outcome measures within the range of values from all reporting NICUs. Understandably, many providers focus primarily, if not exclusively, on their particular value. When a value appears undesirable, providers often justify it in an apparent reflex response rather than critically analysing their data. Exceedingly few reflect on the width or implications of the range within which their performance lies. Standard medical education does not include these skills, yet unwarranted practice variation necessarily compromises a populations overall quality of care. Researchers report wide variation in health care resource use with little connection to patient outcomes, challenging the belief that directing incrementally more resources at certain healthcare problems necessarily produces better results. This book provides requisite knowledge to enable readers without research expertise to understand the notion of unwarranted practice variation, how to recognize it, its ubiquity, and why it is generally undesirable why narrowing is pervasiveness improves quality. The book begins by describing practice variation, its prevalence, and why it matters. Next, it examines alternative conceptualizations of NICU work. One view is task-oriented, while the other is aim-oriented. NICU teams rarely articulate their aims explicitly, so this book offers examples that guide thinking and action. Finally, this book asks, "Which rate is 'right'; what is the performance target?" The answer entails identifying the lowest resource use rate associated with desirable outcomes. This requires data describing efficient and predictably performing provision of current evidence-based care, along with relationships to a variety of outcomes. Provider conceptualization of healthcare quality also is often vague. The challenge lies in defining this notion operationally. This book does precisely that and gives readers tools to think critically about process, outcome, and quality measures, via some understanding of systems, risk-adjustment modelling, and discriminating signal from noise in process data.
Contents:
1. What is practice variation and why should we care about it?
2. Clinical Care: Why do we do what we do? Exactly what are we trying to achieve?
3. How do practice variation and quality improvement efforts relate?
4. The ubiquity of practice variation
5. The Dartmouth Atlas of Neonatal Care. Author: David C. Goodman, MD, MS
6. The Norwegian Neonatal Healthcare Atlas. Author: Atle Moen, MD, PhD
7. NICU Antibiotic Practice Variation
8. Can Performance Feedback Affect NICU Antibiotic Practice Variation?
9. A Single Measure of Antibiotic Practice Variation is Insufficient Hospital Diagnostic Efficiency for Early- and Late-onset Neonatal Sepsis
10. Association Between Inborn NICU Admission rates and Proportion With High Illness Acuity
11. Expanding Our Evaluative Focus
12. The NICU Electronic Medical Record and Performance Evaluation
13. How to Interpret Your Dot: What Does Your Risk-Adjusted Performance Measure Actually Tell You?
14. A Primer on Systems Thinking and Understanding Variation in Care Processes Results Statistical Process Control Methods
15. Practice Variation and (Mis)Aligned Incentives
16. Eliminating Site of Care as an Independent Outcome Determinant
17.Which Rate is "Right?"