Pediatrics
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The Vermont Oxford Network is a voluntary collaborative group of health professionals committed to improving the effectiveness and efficiency of medical care for newborn infants and their families through a coordinated program of research, education, and quality-improvement projects. In support of these activities, the Network maintains a clinical database of information about very low birth weight infants that now has more than 300 participating neonatal intensive care units (NICUs). We anticipate that these NICUs will submit data for 25 000 infants with birth weights of 401 to 1500 g born in 1998. ⋯ During the collaborative, participants will contribute to a knowledge bank of clinical, organizational, and operational change ideas for improving neonatal care. The coordinated program of research, education, and quality improvement described in this article is only possible because of the voluntary efforts of the members. The Network will continue to support these efforts by developing and providing improved tools and resources for the practice of evidence-based neonatology.neonatology, very low birth weight, database, network, quality improvement, evidence-based medicine, randomization, trials, outcomes, mortality, length of stay.
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Review Comparative Study Historical Article
Structure and performance of different DRG classification systems for neonatal medicine.
There are a number of Diagnosis-Related Group (DRG) classification systems that have evolved over the past 2 decades, each with their own strengths and weaknesses. DRG systems are used for case-mix trending, utilization management and quality improvement, comparative reporting, prospective payment, and price negotiations. For any of these applications it is essential to know the accuracy with which the DRG system classifies patients, specifically for predicting resource use and also mortality. ⋯ There is very substantial overpayment for other rural hospitals. The AP-DRGs remove the majority of the systematic effects but significant biases remain. The APR-DRGs remove most of the systematic effects but some biases remain.
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Measures of health status, functional abilities, and quality-of-life are being used increasingly to evaluate health care practice, and to measure outcomes from the patient's perspective. There is thus a need to reassess the use of growth and neurodevelopmental status that have traditionally been used as measures of outcome after neonatal intensive care. The quality of neonatal intensive care constitutes only one factor among many that determine the functional health and quality-of-life of survivors of neonatal intensive care. ⋯ Examination of the proximal neonatal impairments that predispose to later disability, such as rates of periventricular hemorrhage or retinopathy of prematurity, are probably better measures for evaluating quality of neonatal care rather than distal impairments such as cerebral palsy, growth impairments, or reactive airway disease. The ultimate goal of neonatal intensive care is to provide survival without impairment. Objective measures of specific impairments and their residual disability are thus better measures of the quality of neonatal intensive care than subjective assessments of children and their families.
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Comparative Study
Evaluation of risk assessment questions used to target blood lead screening in Illinois.
Beginning in 1995, Illinois law permitted targeted-as opposed to universal-blood lead screening in low-risk areas, which were defined by ZIP code characteristics. State guidelines recommended specific lead risk assessment questions to use when targeting screening. This study was designed to evaluate the sensitivity and specificity of Illinois lead risk assessment questions. ⋯ The Illinois lead risk assessment questions identified most children with an elevated BLL. Using these questions, the majority of Illinois children in low-risk areas will continue to need a blood lead test. This first example of a statewide screening strategy using ZIP code risk designation and risk assessment questions will need further refinement to limit numbers of children tested. In the interim, this strategy is a logical next step after universal screening.