Accelerating Adoption of Comparative Effectiveness Research in Premature Infants

Duke University, Durham NC

Investigators

Abstract

DESCRIPTION (provided by applicant): We know from existing comparative effectiveness research that certain feeding practices and therapeutics result in overall harm to preterm infants. We have shown that a large number of preterm infants are currently exposed to these therapies. This proposal will change prescribing and feeding practices and measure these practice changes in 25% of very low birth weight (<1500 g birth weight) infants born in the US. These changes will influence enteral nutrition (affecting all infants) and the use of 6 of the 12 most common medications (antibiotics, antacids, and steroids) administered in the neonatal intensive care unit. We will use an existing electronic medical record containing detailed healthcare information for 12,000 premature infants a year. We will implement the findings from comparative effectiveness research in 2 phases. The first phase will consist of practitioner education at a Quality Summit and changes to the electronic point-of-care interface with targeted reminders for feeding and prescribing practices and links to educational resources. Our team will analyze feeding and prescribing data from the electronic medical record, along with patient-level data on demographics to identify the worst-performing neonatal intensive care units for each of the AIMs. We will then use specific educational interventions for these poor-performing units. This proposal will: 1) implement current best practices developed from existing comparative effectiveness research across 278 neonatal intensive care units;2) test compliance with these practices using an existing electronic medical record;3) identify neonatal intensive care units with compliance rates that fall outside of best practices;and 4) use focused interventions to further improve adoption of comparative effectiveness research at these units. The team includes internationally recognized experts with experience conducting comparative effectiveness research using large databases. In the last 10 years, team members have co-authored 40 peer-reviewed articles using the electronic medical record platform that will be the centerpiece for this proposal. In a series of publications, quality improvement initiatives, and educational programs, we have: 1) documented the widespread use of feeding practices and medications associated with harm;2) conducted short-term comparative effectiveness projects;3) changed the behavior of neonatologists throughout the United States;and 4) developed a high-functioning platform to conduct the proposed project. PUBLIC HEALTH RELEVANCE: This proposal is a partnership between academic researchers, government, and private practice neonatologists. We will develop and test interventions to efficiently implement findings from comparative effectiveness research in preterm infants. Access to electronic data regarding feeding and prescribing practices coupled with targeted educational interventions will increase the proportion of preterm infants exposed to human milk feedings and decrease the proportion exposed to unproven medications.