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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.
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.
Joseph Schulman, MD, MS, is a neonatologist. He serves as Director of Neonatal Intensive Care Unit (NICU) Quality Measurement and Improvement, and is a Public Health Medical Officer (grade III), at California Children's Services (CCS) / California Department of Health Care Services (DHCS). He is responsible for CCS NICU standards of care and reviews clinical care and outcomes at more than 125 NICUs across California, which serve more than 50,000 admissions annually.
His many peer-reviewed publications concentrate on NICU performance evaluation and quality improvement, clinical informatics, and infection prevention/antibiotic use. He is the sole author of two books published by BMJ Books/Blackwell/John Wiley: 1) Evaluating the Processes of Neonatal Intensive Care , and 2) Managing Your Patients' Data in the Neonatal and Pediatric Intensive Care Units . Dr. Schulman's work straddles knowledge domains uncommonly integrated by a single individual: clinical neonatology, database design and implementation, analytical and enumerative statistical methods, clinical quality improvement, health services research, and claims data analysis.
Dr. Schulman earned his M.D. degree at the University of Pennsylvania and M.S. degree in the Evaluative Clinical Sciences at Dartmouth College, Center for the Evaluative Clinical Sciences, now called the Dartmouth Institute for Health Policy and Clinical Practice. He completed his neonatal-perinatal medicine fellowship at Duke University Medical Center.
1. What is practice variation and why should we care about it?.- 2. Clinical Care: Why do we do what we do? Exactly what are we trying to achieve?.- 3. How do practice variation and quality improvement efforts relate?.- 4. The ubiquity of practice variation.- 5. The Dartmouth Atlas of Neonatal Care. Author: David C. Goodman, MD, MS.- 6. The Norwegian Neonatal Healthcare Atlas. Author: Atle Moen, MD, PhD.- 7. NICU Antibiotic Practice Variation.- 8. Can Performance Feedback Affect NICU Antibiotic Practice Variation?.- 9. A Single Measure of Antibiotic Practice Variation is Insufficient - Hospital Diagnostic Efficiency for Early- and Late-onset Neonatal Sepsis.- 10. Association Between Inborn NICU Admission rates and Proportion With High Illness Acuity.- 11. Expanding Our Evaluative Focus.- 12. The NICU Electronic Medical Record and Performance Evaluation.- 13. How to Interpret Your Dot: What Does Your Risk-Adjusted Performance Measure Actually Tell You?.- 14. A Primer on Systems Thinking and Understanding Variation in Care Processes Results - Statistical Process Control Methods.- 15. Practice Variation and (Mis)Aligned Incentives.- 16. Eliminating Site of Care as an Independent Outcome Determinant.- 17.Which Rate is "Right"?
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