The Vermont Oxford Network is currently
sponsoring a variety of projects intended to improve the quality and safety of medical
care for newborn infants and their families.
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Evidence-Based Surfactant Therapy for Preterm Infants
- J Horbar, R Soll, L Leviton, G Suresh Co-Principal Investigators
- P Plsek, J Sinclair, M Bracken Consultants
- Funding: Agency for Health Care Research and Quality
A significant gap exists between the evidence favoring early surfactant treatment of high-risk
infants and current practice. This study identified infant, provider and institutional factors
associated with differences in surfactant treatment practices through analysis of the Vermont
Oxford Network Database. The results have been published in the June 2004 issue of
Pediatrics (Horbar JD, et al. Timing of Initial Surfactant Treatment for Infants 23 to 29
Weeks Gestation: Is Routine Practice Evidence Based? Pediatrics 2004;113:1593-1602.)
A randomized controlled trial of a multi-faceted package of quality improvement training and
performance feedback designed to promote evidence-based surfactant therapy has now been completed.
Randomization was at the hospital level. One hundred and fourteen institutions enrolled in the trial
and were randomized to intervention and control groups. The trial results are currently being prepared
for publication.
Measuring the Quality of Care for High Risk Preterm Infants
- J Rogowski, J Horbar, and D Staiger Co-Principal Investigators
- Funding: Agency for Health Care Research and Quality
New statistical techniques developed by Douglas Staiger, PhD of Dartmouth College and the
Bureau for Economic Research at Stanford are being used to create measures of the quality of
care for high-risk preterm infants. By using filtered estimates computed using multiple years
of data for multiple outcomes at multiple hospitals, quality signals can be extracted from noisy
data. These methods have been successfully applied to cardiac care for Medicare patients and
will now be applied to the Vermont Oxford Network Database. The primary grant is to the
Rand Corporation (Jeannette Rogowski, PhD, PI) with a subcontract to the Vermont Oxford Network.
Results of this research have been published (Rogowski J, et al. Indirect Versus Direct Hospital
Quality Indicators for Very Low Birth Weight Infants. JAMA 2004:291;202-209.)
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- J Horbar, Principal Investigator, W Edwards, D Goldmann, J Gray, P Plsek, P
- Shiono, Co-Principal Investigators;
- Funding: Agency for Health Care Research and Quality P20 11583.
The Center is a public-private consortium comprised of the University of Vermont
College of Medicine, Children's Hospital-Harvard Medical School, Beth Israel Deaconess
Medical Center, Dartmouth Medical School, and The Vermont Oxford Network. An important
feature of this public-private partnership is the contribution of resources and
funding that the Vermont Oxford Network will make to the support of the Center.
The partnership between the Center and the Vermont Oxford Network will provide the
crucial linkage between research and health care providers and is a unique opportunity
to rapidly translate research into medical practice at a broad range of NICUs from
around the country.
Our focus is on "Learning from Errors and Communicating that Information."
We will direct our research towards medical errors that occur during the care of
a particularly vulnerable population, high-risk newborn infants. The Center's core
mission is to conduct research aimed at finding ways to effectively learn from and
prevent the medical errors that occur during the care of high-risk newborn infants
and to actively communicate that information to health care professionals and families.
A study by Center investigators documenting the broad range of medical errors that
occur in NICUS appeared in the June 2004 issue of Pediatrics (Suresh G,
et al. Voluntary Anonymous Reporting of Medical Errors. Pediatrics 2004;
113:1619-1627.
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National Principal Investigator:
John Zupancic, MD, MBA,
- National Co-Principal Investigators: Jeffrey Horbar, MD on behalf
of the VON SNAP-II Study Group
Participating Neonatal Intensive Care Units (NICUs) have implemented the SNAP-II
illness severity score during. For this study, researchers will:
- Evaluate the feasibility of implementing SNAP-II data collection at Vermont Oxford
Network member sites.
- Assess the overall score performance and potential scoring distortions in selected
subgroups that may affect interpretation.
- Develop selected severity-adjusted quality reports
- Publish a joint research paper on some aspect of severity scoring.