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Books > Medicine > Clinical & internal medicine > Paediatric medicine > Neonatal medicine
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The Problem of Practice Variation in Newborn Medicine - Critical Insights for Evaluating and Improving Quality (Paperback, 1st ed. 2022)
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The Problem of Practice Variation in Newborn Medicine - Critical Insights for Evaluating and Improving Quality (Paperback, 1st ed. 2022)
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Neonatal intensive care unit (NICU) teams in the US and around the
world receive performance reports that locate their particular
value for selected process and outcome measures within the range of
values from all reporting NICUs. Understandably, many providers
focus primarily, if not exclusively, on their particular value.
When a value appears undesirable, providers often justify it in an
apparent reflex response rather than critically analysing their
data. Exceedingly few reflect on the width or implications of the
range within which their performance lies. Standard medical
education does not include these skills, yet unwarranted practice
variation necessarily compromises a population's overall quality of
care. Researchers report wide variation in health care resource use
with little connection to patient outcomes, challenging the belief
that directing incrementally more resources at certain healthcare
problems necessarily produces better results. This book provides
requisite knowledge to enable readers without research expertise to
understand the notion of unwarranted practice variation, how to
recognize it, its ubiquity, and why it is generally undesirable -
why narrowing is pervasiveness improves quality. The book begins by
describing practice variation, its prevalence, and why it matters.
Next, it examines alternative conceptualizations of NICU work. One
view is task-oriented, while the other is aim-oriented. NICU teams
rarely articulate their aims explicitly, so this book offers
examples that guide thinking and action. Finally, this book asks,
"Which rate is 'right'; what is the performance target?" The answer
entails identifying the lowest resource use rate associated with
desirable outcomes. This requires data describing efficient and
predictably performing provision of current evidence-based care,
along with relationships to a variety of outcomes. Provider
conceptualization of healthcare quality also is often vague. The
challenge lies in defining this notion operationally. This book
does precisely that and gives readers tools to think critically
about process, outcome, and quality measures, via some
understanding of systems, risk-adjustment modelling, and
discriminating signal from noise in process data.
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