Characteristics of High Versus Low-Performing Hospitals for Very Preterm Infant Morbidity and Mortality
Objective: To ascertain organizational attributes, policies, and practices that differentiate hospitals with high versus low risk-adjusted rates of very preterm neonatal morbidity and mortality (NMM). Methods: Using a positive deviance research framework, we conducted qualitative interviews of hospi...
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| Format: | Article |
| Language: | English |
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Elsevier
2023-01-01
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| Series: | The Journal of Pediatrics: X |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2590042023000101 |
| _version_ | 1797376632092098560 |
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| author | Shoshanna Sofaer, DrPH Kimberly B. Glazer, PhD, MPH Amy Balbierz, MPH Anna Kheyfets, BA Jennifer Zeitlin, ScD Elizabeth A. Howell, MD, MPP |
| author_facet | Shoshanna Sofaer, DrPH Kimberly B. Glazer, PhD, MPH Amy Balbierz, MPH Anna Kheyfets, BA Jennifer Zeitlin, ScD Elizabeth A. Howell, MD, MPP |
| author_sort | Shoshanna Sofaer, DrPH |
| collection | DOAJ |
| description | Objective: To ascertain organizational attributes, policies, and practices that differentiate hospitals with high versus low risk-adjusted rates of very preterm neonatal morbidity and mortality (NMM). Methods: Using a positive deviance research framework, we conducted qualitative interviews of hospital leadership and frontline clinicians from September-October 2018 in 4 high-performing and 4 low-performing hospitals in New York City, based on NMM measured in previous research. Key interview topics included NICU physician and nurse staffing, professional development, standardization of care, quality measurement and improvement, and efforts to measure and report on racial/ethnic disparities in care and outcomes for very preterm infants. Interviews were audiotaped, professionally transcribed, and coded using NVivo software. In qualitative content analysis, researchers blinded to hospital performance identified emergent themes, highlighted illustrative quotes, and drew qualitative comparisons between hospital clusters. Results: The following features distinguished high-performing facilities: 1) stronger commitment from hospital leadership to diversity, quality, and equity; 2) better access to specialist physicians and experienced nursing staff; 3) inclusion of nurses in developing clinical policies and protocols, and 4) acknowledgement of the influence of racism and bias in healthcare on racial-ethnic disparities. In both clusters, areas for improvement included comprehensive family engagement strategies, care standardization, and reporting of quality data by patient sociodemographic characteristics. Conclusions and relevance: Our findings suggest specific organizational and cultural characteristics, from hospital leadership and clinician perspectives, that may yield better patient outcomes, and demonstrate the utility of a positive deviance framework to center equity in quality initiatives for high-risk infant care. |
| first_indexed | 2024-03-08T19:41:27Z |
| format | Article |
| id | doaj.art-537b73ad1d9e41bca27a3b1884598e19 |
| institution | Directory Open Access Journal |
| issn | 2590-0420 |
| language | English |
| last_indexed | 2024-03-08T19:41:27Z |
| publishDate | 2023-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | The Journal of Pediatrics: X |
| spelling | doaj.art-537b73ad1d9e41bca27a3b1884598e192023-12-25T04:07:11ZengElsevierThe Journal of Pediatrics: X2590-04202023-01-0110100094Characteristics of High Versus Low-Performing Hospitals for Very Preterm Infant Morbidity and MortalityShoshanna Sofaer, DrPH0Kimberly B. Glazer, PhD, MPH1Amy Balbierz, MPH2Anna Kheyfets, BA3Jennifer Zeitlin, ScD4Elizabeth A. Howell, MD, MPP5School of Public Affairs, Baruch College, New York, NYDepartment of Population Health Science and Policy, Blavatnik Family Women's Health Research Institute, The Raquel and Jaime Gilinski Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY; Reprint requests: Kimberly B. Glazer, PhD, MPH, Department of Population Health Science and Policy, The Raquel and Jaime Gilinski Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY.New York University Grossman School of Medicine, New York, NYDepartment of Public Health & Community Medicine, Tufts University School of Medicine, Boston, MAUniversité de Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, Inserm, Inrae, Paris, FranceDepartment of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PAObjective: To ascertain organizational attributes, policies, and practices that differentiate hospitals with high versus low risk-adjusted rates of very preterm neonatal morbidity and mortality (NMM). Methods: Using a positive deviance research framework, we conducted qualitative interviews of hospital leadership and frontline clinicians from September-October 2018 in 4 high-performing and 4 low-performing hospitals in New York City, based on NMM measured in previous research. Key interview topics included NICU physician and nurse staffing, professional development, standardization of care, quality measurement and improvement, and efforts to measure and report on racial/ethnic disparities in care and outcomes for very preterm infants. Interviews were audiotaped, professionally transcribed, and coded using NVivo software. In qualitative content analysis, researchers blinded to hospital performance identified emergent themes, highlighted illustrative quotes, and drew qualitative comparisons between hospital clusters. Results: The following features distinguished high-performing facilities: 1) stronger commitment from hospital leadership to diversity, quality, and equity; 2) better access to specialist physicians and experienced nursing staff; 3) inclusion of nurses in developing clinical policies and protocols, and 4) acknowledgement of the influence of racism and bias in healthcare on racial-ethnic disparities. In both clusters, areas for improvement included comprehensive family engagement strategies, care standardization, and reporting of quality data by patient sociodemographic characteristics. Conclusions and relevance: Our findings suggest specific organizational and cultural characteristics, from hospital leadership and clinician perspectives, that may yield better patient outcomes, and demonstrate the utility of a positive deviance framework to center equity in quality initiatives for high-risk infant care.http://www.sciencedirect.com/science/article/pii/S2590042023000101very pretermhigh-risk neonatequality improvementdisparitiesinfant healthhospital quality |
| spellingShingle | Shoshanna Sofaer, DrPH Kimberly B. Glazer, PhD, MPH Amy Balbierz, MPH Anna Kheyfets, BA Jennifer Zeitlin, ScD Elizabeth A. Howell, MD, MPP Characteristics of High Versus Low-Performing Hospitals for Very Preterm Infant Morbidity and Mortality The Journal of Pediatrics: X very preterm high-risk neonate quality improvement disparities infant health hospital quality |
| title | Characteristics of High Versus Low-Performing Hospitals for Very Preterm Infant Morbidity and Mortality |
| title_full | Characteristics of High Versus Low-Performing Hospitals for Very Preterm Infant Morbidity and Mortality |
| title_fullStr | Characteristics of High Versus Low-Performing Hospitals for Very Preterm Infant Morbidity and Mortality |
| title_full_unstemmed | Characteristics of High Versus Low-Performing Hospitals for Very Preterm Infant Morbidity and Mortality |
| title_short | Characteristics of High Versus Low-Performing Hospitals for Very Preterm Infant Morbidity and Mortality |
| title_sort | characteristics of high versus low performing hospitals for very preterm infant morbidity and mortality |
| topic | very preterm high-risk neonate quality improvement disparities infant health hospital quality |
| url | http://www.sciencedirect.com/science/article/pii/S2590042023000101 |
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