Benchmarking Initiative to Reduce Bronchopulmonary Dysplasia - Full Text View

Purpose

This study tested whether Neonatal Intensive Care Unit (NICU) teams trained in benchmarking -- comparing care practices between different NICUs to see which practices prevent bronchopulmonary dysplasia (BPD) -- and quality improvement would change practices and improve rates of survival without BPD in inborn neonates with birth weights of <1250 grams. Benchmarking is a method involving detailed comparisons of processes between similar organizations. For this study, three NRN centers with the lowest rates of BPD have been identified as Benchmark centers. During a 6-month pre-intervention period, details of care practices and management style at these centers were carefully assessed. Based on practices at these Benchmarking sites, we developed a quality improvement program. For this study, 14 other NRN sites were randomized to either implement the benchmarking intervention (intervention sites) or continue with their usual care practices (control sites). After the 1-year intervention period, we compared changes in the rate of survival without BPD at 36 weeks corrected age between the intervention and control sites.

Condition	Intervention
Infant, Newborn Infant, Low Birth Weight Infant, Small for Gestational Age Infant, Premature Bronchopulmonary Dysplasia	Other: Benchmarking Management Practices Other: Standard Management Practices

Study Type:	Interventional
Study Design:	Allocation: Randomized Endpoint Classification: Efficacy Study Intervention Model: Parallel Assignment Masking: Open Label Primary Purpose: Prevention
Official Title:	Randomized Controlled Trial of Benchmarking to Reduce Bronchopulmonary Dysplasia to Reduce Bronchopulmonary Dysplasia

Resource links provided by NLM:

MedlinePlus related topics: Birth Weight Premature Babies

U.S. FDA Resources

Further study details as provided by Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD):

Primary Outcome Measures:

Survival without BPD [ Time Frame: 36 weeks of life ] [ Designated as safety issue: Yes ]

Secondary Outcome Measures:

Bronchopulmonary Dysplasia [ Time Frame: 36 weeks of life ] [ Designated as safety issue: Yes ]

Enrollment:	4095
Study Start Date:	March 2001
Study Completion Date:	May 2004
Primary Completion Date:	May 2004 (Final data collection date for primary outcome measure)

Arms	Assigned Interventions
Active Comparator: Intervention Clinical sites randomized to intervention will receive training in the benchmarking BPD management methods identified at the Benchmark sites.	Other: Benchmarking Management Practices The Benchmarking intervention included: Data feedback: Using existing data from the NRN Generic Database and Key Care Practices Survey at their NICU to collect data on the perceptions of care. Training in Continuous Quality Improvement (CQI) Techniques Review of best existing evidence Site visits to the Centers with the Lowest Rates of BPD Selection of Practices to change: Each site team selected practices for modification at their own center
Placebo Comparator: Control Clinical sites randomized to Control will continue with their normal management practices for BPD.	Other: Standard Management Practices Centers assigned to the control group continued to receive routine information on their own center's outcomes, and all information routinely supplied within the NRN. Control centers did not participate in organized discussions of the interventions applied within the Benchmarking centers. At the completion of the study, Control Centers were offered a workshop on the Benchmarking techniques.

Arms

Assigned Interventions

Active Comparator: Intervention

Clinical sites randomized to intervention will receive training in the benchmarking BPD management methods identified at the Benchmark sites.

Other: Benchmarking Management Practices

The Benchmarking intervention included:

Data feedback: Using existing data from the NRN Generic Database and Key Care Practices Survey at their NICU to collect data on the perceptions of care.
Training in Continuous Quality Improvement (CQI) Techniques
Review of best existing evidence
Site visits to the Centers with the Lowest Rates of BPD
Selection of Practices to change: Each site team selected practices for modification at their own center

Placebo Comparator: Control

Clinical sites randomized to Control will continue with their normal management practices for BPD.

Other: Standard Management Practices

Centers assigned to the control group continued to receive routine information on their own center's outcomes, and all information routinely supplied within the NRN. Control centers did not participate in organized discussions of the interventions applied within the Benchmarking centers. At the completion of the study, Control Centers were offered a workshop on the Benchmarking techniques.

Detailed Description:

In 1998, 55% of Very Low Birth Weight (VBLW) infants (those born at <1,250g) born at centers in the National Institute of Child Health and Human Development (NICHD) Neonatal Research Network (NRN) either died or developed BPD.

Previous studies within the NICHD Neonatal Research Network showed substantial differences in the incidence of BPD between centers. These differences were not explained by birth weight, gestational age, race, frequency of antenatal steroid use, or incidence of respiratory distress syndrome. Practice differences may contribute to BPD incidence variation. This study evaluated the efficacy of a Benchmarking Initiative to modify clinical care practices and decrease incidence of BPD in VLBW infants.

This study tested whether Neonatal Intensive Care Unit (NICU) teams trained in benchmarking -- comparing care practices between different NICUs to see which practices prevent bronchopulmonary dysplasia (BPD) -- and quality improvement would change practices and improve rates of survival without BPD in inborn neonates with birth weights of <1250 grams. Benchmarking is a method involving detailed comparisons of processes between similar organizations. For this study, three NRN centers with the lowest rates of BPD have been identified as Benchmark centers. During a 6-month pre-intervention period, details of care practices and management style at these centers were carefully assessed. Based on practices at these Benchmarking sites, we developed a quality improvement program. For this study, 14 other NRN sites were randomized to either implement the benchmarking intervention (intervention sites) or continue with their usual care practices (control sites). After the 1-year intervention period, we compared changes in the rate of survival without BPD at 36 weeks corrected age between the intervention and control sites.

Eligibility

Ages Eligible for Study:	up to 36 Weeks
Genders Eligible for Study:	Both
Accepts Healthy Volunteers:	Yes

Criteria

Inclusion Criteria

Infants 501-1,249g birthweight
Registered in a participating site

Exclusion Criteria

Diagnosed with a syndrome as defined by the Neonatal Research Network's Generic Database Study

Contacts and Locations

Please refer to this study by its ClinicalTrials.gov identifier: NCT00067613

Locations

United States, Alabama
University of Alabama at Birmingham
Birmingham, Alabama, United States, 35233
United States, California
Stanford University
Palo Alto, California, United States, 94304
University of California at San Diego
San Diego, California, United States, 92103-8774
United States, Connecticut
Yale University
New Haven, Connecticut, United States, 06504
United States, Florida
University of Miami
Miami, Florida, United States, 33136
United States, Georgia
Emory University
Atlanta, Georgia, United States, 30303
United States, Indiana
Indiana University
Indianapolis, Indiana, United States, 46202
United States, Michigan
Wayne State University
Detroit, Michigan, United States, 48201
United States, New York
University of Rochester
Rochester, New York, United States, 14642
United States, North Carolina
Wake Forest University
Charlotte, North Carolina, United States, 27157
Duke University
Durham, North Carolina, United States, 27710
RTI International
Durham, North Carolina, United States, 27705
United States, Ohio
Cincinnati Children's Medical Center
Cincinnati, Ohio, United States, 45267
Case Western Reserve University, Rainbow Babies and Children's Hospital
Cleveland, Ohio, United States, 44106
United States, Rhode Island
Brown University, Women & Infants Hospital of Rhode Island
Providence, Rhode Island, United States, 02905
United States, Texas
University of Texas Southwestern Medical Center at Dallas
Dallas, Texas, United States, 75235
University of Texas Health Science Center at Houston
Houston, Texas, United States, 77030

Sponsors and Collaborators

Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)

National Center for Research Resources (NCRR)

Investigators

Study Director:	Michele C. Walsh, MD	Case Western Reserve University, Rainbow Babies & Children's Hospital
Principal Investigator:	William Oh, MD	Brown University, Women & Infants Hospital of Rhode Island
Principal Investigator:	Waldemar A. Carlo, MD	University of Alabama at Birmingham
Principal Investigator:	Shahnaz Duara, MD	University of Miami
Principal Investigator:	Barbara J. Stoll, MD	Emory University
Principal Investigator:	James A. Lemons, MD	Indiana University
Principal Investigator:	David K. Stevenson, MD	Stanford University
Principal Investigator:	Neil N. Finer, MD	University of California, San Diego
Principal Investigator:	Abbot R. Laptook, MD	University of Texas Southwestern Medical Center
Principal Investigator:	Seetha Shankaran, MD	Wayne State University
Principal Investigator:	Edward F. Donovan, MD	Children's Hospital Medical Center, Cincinnati
Principal Investigator:	Ronald N. Goldberg, MD	Duke University
Principal Investigator:	Dale L. Phelps, MD	University of Rochester
Principal Investigator:	Jon E. Tyson, MD MPH	The University of Texas Health Science Center, Houston
Principal Investigator:	T. Michael O'Shea, MD MPH	Wake Forest University
Principal Investigator:	Richard A. Ehrenkranz, MD	Yale University
Principal Investigator:	W. Kenneth Poole, PhD	RTI International

More Information

Additional Information:

NICHD Neonatal Research Network This link exits the ClinicalTrials.gov site

NICHD Pregnancy & Perinatology Branch This link exits the ClinicalTrials.gov site

Publications:

Bhandari V, Finer NN, Ehrenkranz RA, Saha S, Das A, Walsh MC, Engle WA, VanMeurs KP; Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Synchronized nasal intermittent positive-pressure ventilation and neonatal outcomes. Pediatrics. 2009 Aug;124(2):517-26. Epub 2009 Jul 27.

Laptook AR, Salhab W, Allen J, Saha S, Walsh M. Pulse oximetry in very low birth weight infants: can oxygen saturation be maintained in the desired range? J Perinatol. 2006 Jun;26(6):337-41.

Shankaran S, Langer JC, Kazzi SN, Laptook AR, Walsh M; National Institute of Child Health and Human Development Neonatal Research Network. Cumulative index of exposure to hypocarbia and hyperoxia as risk factors for periventricular leukomalacia in low birth weight infants. Pediatrics. 2006 Oct;118(4):1654-9.

Walsh M, Laptook A, Kazzi SN, Engle WA, Yao Q, Rasmussen M, Buchter S, Heldt G, Rhine W, Higgins R, Poole K; National Institute of Child Health and Human Development Neonatal Research Network. A cluster-randomized trial of benchmarking and multimodal quality improvement to improve rates of survival free of bronchopulmonary dysplasia for infants with birth weights of less than 1250 grams. Pediatrics. 2007 May;119(5):876-90.

Walsh M, Engle W, Laptook A, Kazzi SN, Buchter S, Rasmussen M, Yao Q; National Institute of Child Health and Human Development Neonatal Research Network. Oxygen delivery through nasal cannulae to preterm infants: can practice be improved? Pediatrics. 2005 Oct;116(4):857-61.

Wilson-Costello D, Walsh MC, Langer JC, Guillet R, Laptook AR, Stoll BJ, Shankaran S, Finer NN, Van Meurs KP, Engle WA, Das A; Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Impact of postnatal corticosteroid use on neurodevelopment at 18 to 22 months' adjusted age: effects of dose, timing, and risk of bronchopulmonary dysplasia in extremely low birth weight infants. Pediatrics. 2009 Mar;123(3):e430-7. Epub 2009 Feb 9.

Responsible Party:	Michele C. Walsh, Lead Principal Investigator, Case Western Reserve University
ClinicalTrials.gov Identifier:	NCT00067613 History of Changes
Other Study ID Numbers:	NICHD-NRN-0025, U10HD034216, U10HD021364, U10HD027853, U10HD027851, U01HD036790, U10HD027856, U10HD021397, U10HD027881, U10HD027880, U10HD021415, U10HD021373, U10HD021385, U10HD027871, U10HD034167, U10HD027904, M01RR008084, M01RR000750, M01RR000997, M01RR000070, M01RR006022, M01RR002635, M01RR002172, M01RR001032
Study First Received:	August 25, 2003
Last Updated:	January 9, 2011
Health Authority:	United States: Federal Government United States: Institutional Review Board

Keywords provided by Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD):

NICHD Neonatal Research Network
Extremely Low Birth Weight (ELBW)
Very Low Birth Weight (VLBW)
Prematurity

Mechanical ventilation
Benchmarking
Chronic Lung Disease (CLD)

Additional relevant MeSH terms:

Birth Weight
Bronchopulmonary Dysplasia
Hyperplasia
Body Weight
Signs and Symptoms
Ventilator-Induced Lung Injury

Lung Injury
Lung Diseases
Respiratory Tract Diseases
Infant, Premature, Diseases
Infant, Newborn, Diseases
Pathologic Processes

ClinicalTrials.gov processed this record on May 21, 2013