The Swiss Neonatal Quality Cycle, a monitor for clinical performance and tool for quality improvement

BACKGROUND We describe the setup of a neonatal quality improvement tool and list which peer-reviewed requirements it fulfils and which it does not. We report on the so-far observed effects, how the units can identify quality improvement potential, and how they can measure the effect of changes made to improve quality. METHODS Application of a prospective longitudinal national cohort data collection that uses algorithms to ensure high data quality (i.e. checks for completeness, plausibility and reliability), and to perform data imaging (Plsek's p-charts and standardized mortality or morbidity ratio SMR charts). The collected data allows monitoring a study collective of very low birth-weight infants born from 2009 to 2011 by applying a quality cycle following the steps 'guideline - perform - falsify - reform'. RESULTS 2025 VLBW live-births from 2009 to 2011 representing 96.1% of all VLBW live-births in Switzerland display a similar mortality rate but better morbidity rates when compared to other networks. Data quality in general is high but subject to improvement in some units. Seven measurements display quality improvement potential in individual units. The methods used fulfil several international recommendations. CONCLUSIONS The Quality Cycle of the Swiss Neonatal Network is a helpful instrument to monitor and gradually help improve the quality of care in a region with high quality standards and low statistical discrimination capacity

Comparison of three different methods for risk adjustment in neonatal medicine

Abstract Background Quality improvement in health care requires identification of areas in need of improvement by comparing processes and patient outcomes within and between health care providers. It is critical to adjust for different case-mix and outcome risks of patient populations but it is currently unclear which approach has higher validity and how limitations need to be dealt with. Our aim was to compare 3 approaches towards risk adjustment for 7 different major quality indicators in neonatal intensive care (21 models). Methods We compared an indirect standardization, logistic regression and multilevel approach. Parameters for risk adjustment were chosen according to literature and the condition that they may not depend on processes performed by treating clinics. Predictive validity was tested using the mean Brier Score and by comparing area under curve (AUC) using high quality population based data separated into training and validation sets. Changes in attributional validity were analysed by comparing the effect of the models on the observed-to-expected ratios of the clinics in standardized mortality/morbidity ratio charts. Results Risk adjustment based on indirect standardization revealed inferior c-statistics but superior Brier scores for 3 of 7 outcomes. Logistic regression and multilevel modelling were equivalent to one another. C-statistics revealed that predictive validity was high for 8 and acceptable for 11 of the 21 models. Yet, the effect of all forms of risk adjustment on any clinic’s comparison with the standard was small, even though there was clear risk heterogeneity between clinics. Conclusions All three approaches to risk adjustment revealed comparable results. The limited effect of risk adjustment on clinic comparisons indicates a small case-mix influence on observed outcomes, but also a limited ability to isolate quality improvement potential based on risk-adjustment models. Rather than relying on methodological approaches, we instead recommend that clinics build small collaboratives and compare their indicators both in risk-adjusted and unadjusted form together. This allows qualitatively investigating and discussing the residual risk-differences within networks. The predictive validity should be quantified and reported and stratification into risk groups should be more widely used to correct for confounding

Desarrollo lingüístico y expresión autobiográfica: secuencia de fotos con un álbum fotográfico

Este trabajo plantea una propuesta metodológica para educación infantil con la que comprender el tiempo histórico partiendo de la interpretación de imágenes personales, familiares y patrimoniales. El objetivo último de la secuencia didáctica es que el sujeto construya un discurso narrativo en tercera persona a partir del discurso autobiográfico inicial mediante la utilización de las fotografías de su álbum personal- familiar, ampliado a imágenes del patrimonio local. Con este material, se pretende que el sujeto identifique conceptos históricos como el cambio, la duración o la continuidad en diferentes contextos, tanto personales como sociales. Esta propuesta metodológica responde a las expectativas de la didáctica de la lengua y de las ciencias sociales en la etapa de educación infantil, es decir, construir un estudio del pasado desde la interpretación de los hechos desde el presente. Desarrollará habilidades, capacidades, destrezas y actitudes que le permitan pasar de una descripción autobiográfica a una narración histórica; de lo conocido a lo desconocido; construyendo, así, un patrimonio cultural, un pensamiento con explicación histórica, además, de fomentar con todo ello, la comunicación lingüística del sujeto.This work raises a methodological proposal for children education, aimed at understanding the history, based on the interpretation of personal images, family and cultural heritage. The ultimate goal of this didactic sequence is the subject building a third person narrative discourse, starting from their autobiographical discourse by using their own family pictures, complemented with pictures of the local heritage. With this material, it is intended that the subject identifies concepts as historical change, the duration or continuity of different contexts, both personal and social. This methodological proposal responds to the expectations of the Didactics of Language and the Social Sciences in the stage of child education, it is to say, building a study of the past by interpreting the facts of the present. The subject will develop skills, abilities and attitudes which will allow him to move from an autobiographical description to a historical narration; from the known to the unknown; building, as well, a cultural heritage, a thought with historical explanation, moreover, to promote with all this, the linguistic communication of the subject.Graduado o Graduada en Maestro en Educación Infantil por la Universidad Pública de NavarraHaur Hezkuntzako Irakasletzan Graduatua Nafarroako Unibertsitate Publikoa

Variability of Very Low Birth Weight Infant Outcome and Practice in Swiss and US Neonatal Units

Outcomes of very preterm infants vary considerably between health care facilities. Our objective was to compare outcome and practices between the Swiss Neonatal Network (SNN) and US members of the Vermont Oxford Network (US-VON)