Sequential analysis for quality control in the neonatal intensive care unit.

OBJECTIVE: This article describes a novel application of a statistical technique for continuous quality assurance in the NICU. METHODS: We used prospective analysis of rates of survival to 28 days of life, without major IVH in ELBW infants in a single tertiary NICU, before and after the introduction of an evidence-based treatment protocol. By using the CUSUM function, each infant's results were sequentially plotted, and significant changes in outcomes were noted when the plot crossed predetermined boundary lines. RESULTS: Significant changes in outcomes were evident with this method sooner than traditional analyses on the basis of year-end or other arbitrary intervals. The introduction of the ELBW protocol was temporally associated with significant improvement in intact short-term survival. CONCLUSION: Sequential analysis techniques are useful tools for ongoing quality assurance; deviations in outcomes may be detected more quickly, which should assist in the identification of improvements or decrements in performance of the NICU.

Effect of economic status on the use of house dust mite avoidance measures in asthmatic children.

To assess the effect of socioeconomic status on compliance with house dust mite avoidance measures, we interviewed the parents of 60 mite-allergic, asthmatic children about mite avoidance. Thirty were of lower socioeconomic status and 30 were of higher socioeconomic status, as determined by the type of insurance. All had previously learned mite avoidance measures at the time of diagnosis. Twenty of 30 lower socioeconomic status parents had removed stuffed toys from the child's bedroom compared with only 12 of 30 higher socioeconomic status parents (P = .07). Twelve of 30 parents in the lower socioeconomic status group had obtained plastic mattress covers compared with 22 of the 30 higher socioeconomic status parents (P = .018). Eighteen parents in the lower socioeconomic status group expressed reasons for not obtaining plastic covers. Nine cited lack of funds, four did not know where to buy them, and four did not think it would help. Of the eight parents in the higher socioeconomic status group that did not obtain covers, six cited inconvenience and two thought it would not help. We conclude that education alone will not ensure compliance with house dust mite controls. Economic factors influence utilization. Access to free or low cost mite-proof pillow and mattress covers may improve asthma care for poor children.