The effect of professional-led guideline workshops on clinical practice for the management of patent ductus arteriosus in preterm neonates in Japan: a controlled before-and-after study

Implementation Science

Rintaro Mori⁴  Katsuaki Toyoshima⁷  Masanori Fujimura⁶  Satoshi Kusuda³  Sadequa Shahrook⁴  Hideko Mitsuhashi³  Hiroo Chiba⁵  Hironobu Tokumasu²  Xiang Y Ye¹  Tetsuya Isayama¹ 

[1] Maternal-Infant Care Research Center, Mount Sinai Hospital, Toronto, ON, Canada;Department of Consultation, Kurashiki Clinical Research Institute, Okayama, Japan;Maternal and Perinatal Center, Tokyo Women’s Medical University, Tokyo, Japan;Department of Health Policy, National Center for Child Health and Development, 2-10-1, Okura, Setagaya-ku, Tokyo 157-8535, Japan;Division of Pediatrics, Sendai City Hospital, Sendai, Japan;Osaka Medical Center and Research Institute for Maternal and Child Health, Izumi, Japan;Department of Neonatology, Kanagawa Children’s Medical Center, Kanagawa, Japan

关键词: Translational medical research;    Information dissemination;    Morbidity;    Mortality;    Premature infants;    Patent ductus arteriosus;    Clinical practice guideline;    Preterm infants;    Neonatology;    Pediatrics;   

Others  :  1218376
DOI  :  10.1186/s13012-015-0258-5

 received in 2014-10-04, accepted in 2015-04-29,  发布年份 2015

【 摘 要 】

Background

Clinical guidelines assist physicians to make decisions about suitable healthcare. We conducted a controlled before-and-after study to investigate the impact of professional-led guideline workshops for patent ductus arteriosus (PDA) management on physicians’ clinical practices, discharge mortality, and associated morbid conditions among preterm neonates.

Methods

We recruited physicians practicing at two neonatal intensive care units (NICUs) in Japan and used the data of all neonates weighing less than or equal to 1,500 g admitted to 90 NICUs (2 intervention NICUs and 88 control NICUs) in the Neonatal Research Network of Japan from April 2008 to March 2010. We held 1-day workshops for physicians on PDA clinical practice guidelines at the two intervention NICUs. Physicians’ skills assessed by confidence rating (CR) scores and the Sheffield Peer Review Assessment Tool (SPRAT) were compared between pre- and post-workshop month at the intervention NICUs using Wilcoxon signed-rank tests. Neonatal discharge mortality and morbidity were compared between pre- and post-workshop year at both the intervention and control NICUs using multivariable regression analyses adjusting for potential confounders.

Results

Fifteen physicians were included in the study. Physicians’ CR scores (2.14 vs. 2.47, p = 0.02) and SPRAT (4.14 vs. 4.50, p = 0.05) in PDA management improved after the workshops. The analyses of neonatal outcomes included 294 and 6,234 neonates in the intervention and control NICUs, respectively. Neonates’ discharge mortality declined sharply at the intervention NICUs (from 15/146 to 5/148, relative risk reduction −0.67; adjusted odds ratio 0.30, 95% confidence interval 0.10 to 0.89) during the post-workshop period. The mortality reduction was much greater than that in the control NICUs (from 207/3,322 to 147/2,912, relative risk reduction −0.19; adjusted odds ratio 0.75, 95% confidence interval 0.59 to 0.95), although the difference between the intervention and control NICUs were not statistically significant.

Conclusions

Overall, physicians’ confidence in PDA management improved after attending guideline workshops. Face-to-face workshops by guideline developers can be a useful strategy to improve physicians’ PDA management skills and, thereby, might reduce PDA-associated mortality in preterm neonates.

【 授权许可】

   
2015 Isayama et al.; licensee BioMed Central.

【 图 表 】

Figure 1.

Figure 2.

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