Bio

Bio


My primary research interest is the effect of health system design on quality of care and outcomes for sick newborns. This interest includes health care delivery design at the macro-system level as well as organizational context at the hospital and neonatal intensive care unit level. In addition, I am interested in the use of information technology to support families, care professionals, and policy makers in their efforts to provide optimal care to sick infants.

Academic Appointments


Boards, Advisory Committees, Professional Organizations


  • Member, Academy Health (2010 - Present)
  • Member, Society for Pediatric Research (2009 - Present)
  • Fellow, American Academy of Pediatrics (2006 - Present)

Professional Education


  • MPH, Harvard School of Public Health (2005)
  • MD, Albert-Ludwigs-University, Freiburg, Germany (1997)

Research & Scholarship

Current Research and Scholarly Interests


1) Development and application of composite measurement of quality - Baby-MONITOR

2) High reliability, safety culture and caregiver resilience as modifiers of care quality

3) Accountable care organizations and their effect on regionalized care delivery systems for preterm newborns

Publications

Journal Articles


  • Effects of Individual Physician-Level and Practice-Level Financial Incentives on Hypertension Care A Randomized Trial JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION Petersen, L. A., Simpson, K., Pietz, K., Urech, T. H., Hysong, S. J., Profit, J., Conrad, D. A., Dudley, R. A., Woodard, L. D. 2013; 310 (10): 1042-1050

    Abstract

    Pay for performance is intended to align incentives to promote high-quality care, but results have been contradictory.To test the effect of explicit financial incentives to reward guideline-recommended hypertension care.Cluster randomized trial of 12 Veterans Affairs outpatient clinics with 5 performance periods and a 12-month washout that enrolled 83 primary care physicians and 42 nonphysician personnel (eg, nurses, pharmacists).Physician-level (individual) incentives, practice-level incentives, both, or none. Intervention participants received up to 5 payments every 4 months; all participants could access feedback reports.Among a random sample, number of patients achieving guideline-recommended blood pressure thresholds or receiving an appropriate response to uncontrolled blood pressure, number of patients prescribed guideline-recommended medications, and number who developed hypotension.Mean (SD) total payments over the study were $4270 ($459), $2672 ($153), and $1648 ($248) for the combined, individual, and practice-level interventions, respectively. The unadjusted baseline and final percentages and the adjusted absolute change over the study in patients meeting the combined blood pressure/appropriate response measure were 75% to 84% and 8.84% (95% CI, 4.20% to 11.80%) for the individual group, 80% to 85% and 3.70% (95% CI, 0.24% to 7.68%) for the practice-level group, 79% to 88% and 5.54% (95% CI, 1.92% to 9.52%) for the combined group, and 86% to 86% and 0.47% (95% CI, -3.12% to 4.04%) for the control group. The adjusted absolute estimated difference in the change between the proportion of patients with blood pressure control/appropriate response for individual incentive and control groups was 8.36% (95% CI, 2.40% to 13.00%; P=.005). The other incentive groups did not show a significant change compared with controls for this outcome. For medications, the unadjusted baseline and final percentages and the adjusted absolute change were 61% to 73% and 9.07% (95% CI, 4.52% to 13.44%), 56% to 65% and 4.98% (95% CI, 0.64% to 10.08%), 65% to 80% and 7.26% (95% CI, 2.92% to 12.48%), and 63% to 72% and 4.35% (95% CI, -0.28% to 9.28%), respectively. These changes in the use of guideline-recommended medications were not significant in any of the incentive groups compared with controls, nor was the incidence of hypotension. The effect of the incentive was not sustained after a washout.Individual financial incentives, but not practice-level or combined incentives, resulted in greater blood pressure control or appropriate response to uncontrolled blood pressure; none of the incentives resulted in greater use of guideline-recommended medications or increased incidence of hypotension compared with controls. Further research is needed on the factors that contributed to these findings.clinicaltrials.gov Identifier: NCT00302718.

    View details for DOI 10.1001/jama.2013.276303

    View details for Web of Science ID 000324133400021

    View details for PubMedID 24026599

  • Variations in Definitions of Mortality Have Little Influence on Neonatal Intensive Care Unit Performance Ratings JOURNAL OF PEDIATRICS Profit, J., Gould, J. B., Draper, D., Zupancic, J. A., Kowalkowski, M. A., Woodard, L., Pietz, K., Petersen, L. A. 2013; 162 (1): 50-U320

    Abstract

    To measure the influence of varying mortality time frames on performance rankings among regional neonatal intensive care units (NICUs) in a large state.We performed a cross-sectional data analysis of very low birth weight infants receiving care at 24 level 3 NICUs. We tested the effect of 4 definitions of mortality: (1) death between admission and end of birth hospitalization or up to 366 days; (2) death between 12 hours of age and the end of birth hospitalization or up to 366 days; (3) death between admission and 28 days; and (4) death between 12 hours of age and 28 days. NICUs were ranked by quantifying their deviation from risk-adjusted expected mortality and dividing them into 3 tiers: top 6, bottom 6, and in between.There was wide interinstitutional variation in risk-adjusted mortality for each definition (observed minus expected z-score range, -6.08 to 3.75). However, mortality-based NICU rankings and classification into performance tiers were very similar for all institutions in each of our time frames. Among all 4 definitions, NICU rank correlations were high (>0.91). Few NICUs changed relative to a neighboring tier with changes in definitions, and none changed by more than one tier.The time frame used to ascertain mortality had little effect on comparative NICU performance.

    View details for DOI 10.1016/j.jpeds.2012.06.002

    View details for Web of Science ID 000312915900012

    View details for PubMedID 22854328

  • Nurse-to-Patient Ratios and Neonatal Outcomes: A Brief Systematic Review NEONATOLOGY Sherenian, M., Profit, J., Schmidt, B., Suh, S., Xiao, R., Zupancic, J. A., DeMauro, S. B. 2013; 104 (3): 179-183

    Abstract

    Higher patient-to-nurse ratios and nursing workload are associated with increased mortality in the adult intensive care unit (ICU). Most neonatal ICUs (NICUs) in the United Kingdom do not meet national staffing recommendations. The impact of staffing on outcomes in the NICU is unknown.To determine how nurse-to-patient ratios or nursing workload affects outcomes in the NICU.Two authors (M.S., S.S.) searched PubMed, Medline, and EMBASE for eligible studies. Included studies reported on both the outcomes of infants admitted to a NICU and nurse-to-patient ratios or workload, and were published between 1/1990 and 4/2010 in any language. The primary outcome was mortality before discharge, relative to nurse-to-patient ratios. Secondary outcomes were intraventricular hemorrhage, daily weight gain, days on assisted ventilation, days on oxygen and nosocomial infection. Study quality was assessed with the STROBE checklist.Seven studies met the inclusion criteria. Three reported on the same group of patients. Only four studies reported death before discharge from the NICU relative to nurse-to-patient ratios. Three reported an association between lower nurse-to-patient ratios and higher mortality, and one reported just the opposite. Because each study used a different definition of nurse staffing, a meta-analysis could not be performed.Nurse-to-patient ratios appear to affect outcomes of neonatal intensive care, but limitations of the existing literature prevent clear conclusions about optimal staffing strategies. Evidence-based standards for staffing could impact public policy and lead to improvements in patient safety and decreased rates of adverse outcomes. More research on this subject, including a standard and valid measure of nursing workload, is urgently needed.

    View details for DOI 10.1159/000353458

    View details for Web of Science ID 000325241900005

    View details for PubMedID 23941740

  • Correlation of Neonatal Intensive Care Unit Performance Across Multiple Measures of Quality of Care JAMA PEDIATRICS Profit, J., Zupancic, J. A., Gould, J. B., Pietz, K., Kowalkowski, M. A., Draper, D., Hysong, S. J., Petersen, L. A. 2013; 167 (1): 47-54

    Abstract

    To examine whether high performance on one measure of quality is associated with high performance on others and to develop a data-driven explanatory model of neonatal intensive care unit (NICU) performance.We conducted a cross-sectional data analysis of a statewide perinatal care database. Risk-adjusted NICU ranks were computed for each of 8 measures of quality selected based on expert input. Correlations across measures were tested using the Pearson correlation coefficient. Exploratory factor analysis was used to determine whether underlying factors were driving the correlations.Twenty-two regional NICUs in California.In total, 5445 very low-birth-weight infants cared for between January 1, 2004, and December 31, 2007.Pneumothorax, growth velocity, health care-associated infection, antenatal corticosteroid use, hypothermia during the first hour of life, chronic lung disease, mortality in the NICU, and discharge on any human breast milk.The NICUs varied substantially in their clinical performance across measures of quality. Of 28 unit-level correlations, 6 were significant (ρ < .05). Correlations between pairs of measures of quality of care were strong (ρ ≥ .5) for 1 pair, moderate (range, ρ ≥ .3 to ρ < .5) for 8 pairs, weak (range, ρ ≥ .1 to ρ < .3) for 5 pairs, and negligible (ρ < .1) for 14 pairs. Exploratory factor analysis revealed 4 underlying factors of quality in this sample. Pneumothorax, mortality in the NICU, and antenatal corticosteroid use loaded on factor 1; growth velocity and health care-associated infection loaded on factor 2; chronic lung disease loaded on factor 3; and discharge on any human breast milk loaded on factor 4.In this sample, the ability of individual measures of quality to explain overall quality of neonatal intensive care was modest.

    View details for DOI 10.1001/jamapediatrics.2013.418

    View details for Web of Science ID 000316797500010

    View details for PubMedID 23403539

  • Do practicing clinicians agree with expert ratings of neonatal intensive care unit quality measures? JOURNAL OF PERINATOLOGY Kowalkowski, M., Gould, J. B., Bose, C., Petersen, L. A., Profit, J. 2012; 32 (4): 247-252

    Abstract

    To assess the level of agreement when selecting quality measures for inclusion in a composite index of neonatal intensive care quality (Baby-MONITOR) between two panels: one comprised of academic researchers (Delphi) and another comprised of academic and clinical neonatologists (clinician).In a modified Delphi process, a panel rated 28 quality measures. We assessed clinician agreement with the Delphi panel by surveying a sample of 48 neonatal intensive care practitioners. We asked the clinician group to indicate their level of agreement with the Delphi panel for each measure using a five-point scale (much too high, slightly too high, reasonable, slightly too low and much too low). In addition, we asked clinicians to select measures for inclusion in the Baby-MONITOR based on a yes or no vote and a pre-specified two-thirds majority for inclusion.In all, 23 (47.9%) of the clinicians responded to the survey. We found high levels of agreement between the Delphi and clinician panels, particularly across measures selected for the Baby-MONITOR. Clinicians selected the same nine measures for inclusion in the composite as the Delphi panel. For these nine measures, 74% of clinicians indicated that the Delphi panel rating was 'reasonable'.Practicing clinicians agree with an expert panel on the measures that should be included in the Baby-MONITOR, enhancing face validity.

    View details for DOI 10.1038/jp.2011.199

    View details for Web of Science ID 000302189200002

    View details for PubMedID 22241483

  • The Safety Attitudes Questionnaire as a tool for benchmarking safety culture in the NICU ARCHIVES OF DISEASE IN CHILDHOOD-FETAL AND NEONATAL EDITION Profit, J., Etchegaray, J., Petersen, L. A., Sexton, J. B., Hysong, S. J., Mei, M., Thomas, E. J. 2012; 97 (2): F127-F132

    Abstract

    Neonatal intensive care unit (NICU) safety culture, as measured by the Safety Attitudes Questionnaire (SAQ), varies widely. Associations with clinical outcomes in the adult intensive care unit setting make the SAQ an attractive tool for comparing clinical performance between hospitals. Little information is available on the use of the SAQ for this purpose in the NICU setting.To determine whether the dimensions of safety culture measured by the SAQ give consistent results when used as a NICU performance measure.Cross-sectional survey of caregivers in 12 NICUs, using the six scales of the SAQ: teamwork climate, safety climate, job satisfaction, stress recognition, perceptions of management and working conditions. NICUs were ranked by quantifying their contribution to overall risk-adjusted variation across the scales. Spearman rank correlation coefficients were used to test for consistency in scale performance. The authors then examined whether performance in the top four NICUs in one scale predicted top four performance in others.There were 547 respondents in 12 NICUs. Of 15 NICU-level correlations in performance ranking, two were >0.7, seven were between 0.4 and 0.69, and the six remaining were <0.4. The authors found a trend towards significance in comparing the distribution of performance in the top four NICUs across domains with a binomial distribution p=0.051, indicating generally consistent performance across dimensions of safety culture.A culture of safety permeates many aspects of patient care and organisational functioning. The SAQ may be a useful tool for comparative performance assessments among NICUs.

    View details for DOI 10.1136/archdischild-2011-300612

    View details for Web of Science ID 000301633800010

    View details for PubMedID 22337935

  • Neonatal intensive care unit safety culture varies widely ARCHIVES OF DISEASE IN CHILDHOOD-FETAL AND NEONATAL EDITION Profit, J., Etchegaray, J., Petersen, L. A., Sexton, J. B., Hysong, S. J., Mei, M., Thomas, E. J. 2012; 97 (2): F120-F126

    Abstract

    Variation in healthcare delivery and outcomes in neonatal intensive care units (NICUs) may be partly explained by differences in safety culture.To describe NICU care giver assessments of safety culture, explore variability within and between NICUs on safety culture domains, and test for association with care giver characteristics.NICU care givers in 12 hospitals were surveyed using the Safety Attitudes Questionnaire (SAQ), which has six scales: teamwork climate, safety climate, job satisfaction, stress recognition, perception of management and working conditions. Scale means, SDs and percent positives (percent agreement) were calculated for each NICU.There was substantial variation in safety culture domains among NICUs. Composite mean score across the six domains ranged from 56.3 to 77.8 on a 100-point scale and NICUs in the top four NICUs were significantly different from the bottom four (p<0.001). Across the six domains, respondent assessments varied widely, but were least positive on perceptions of management (3%-80% positive; mean 33.3%) and stress recognition (18%-61% positive; mean 41.3%). Comparisons of SAQ scale scores between NICUs and a previously published adult ICU cohort generally revealed higher scores for NICUs. Composite scores for physicians were 8.2 (p=0.04) and 9.5 (p=0.02) points higher than for nurses and ancillary personnel.There is significant variation and scope for improvement in safety culture among these NICUs. The NICU variation was similar to variation in adult ICUs, but NICU scores were generally higher. Future studies should validate whether safety culture measured with the SAQ correlates with clinical and operational outcomes in NICUs.

    View details for DOI 10.1136/archdischild-2011-300635

    View details for Web of Science ID 000301633800009

    View details for PubMedID 21930691

  • Perils and Opportunities of Comparative Performance Measurement ARCHIVES OF PEDIATRICS & ADOLESCENT MEDICINE Profit, J., Woodard, L. D. 2012; 166 (2): 191-194

    View details for Web of Science ID 000301211000015

    View details for PubMedID 22312179

  • Treating Chronically Ill People with Diabetes Mellitus with Limited Life Expectancy: Implications for Performance Measurement JOURNAL OF THE AMERICAN GERIATRICS SOCIETY Woodard, L. D., Landrum, C. R., Urech, T. H., Profit, J., Virani, S. S., Petersen, L. A. 2012; 60 (2): 193-201

    Abstract

    To develop an algorithm to identify individuals with limited life expectancy and examine the effect of limited life expectancy on glycemic control and treatment intensification in individuals with diabetes mellitus.Individuals with diabetes mellitus and coexisting congestive heart failure, chronic obstructive pulmonary disease, dementia, end-stage liver disease, and/or primary or metastatic cancer with limited life expectancy were identified. To validate the algorithm, 5-year mortality was assessed in individuals identified as having limited life expectancy. Rates of meeting performance measures for glycemic control between individuals with and without limited life expectancy were compared. In individuals with uncontrolled glycosylated hemoglobin (HbA(1c) ) levels, the effect of limited life expectancy on treatment intensification within 90 days was examined.One hundred ten Department of Veterans Affairs facilities; October 2006 to September 2007.Eight hundred eighty-eight thousand six hundred twenty-eight individuals with diabetes mellitus.HbA(1c) ; treatment intensification within 90 days of index HbA(1c) reading.Twenty-nine thousand sixteen (3%) participants had limited life expectancy. Adjusting for age, 5-year mortality was five times as high in participants with limited life expectancy than in those without. Participants with limited life expectancy had poorer glycemic control than those without (glycemic control: 77.1% vs 78.1%; odds ratio (OR) = 0.84, 95% confidence interval (CI) = 0.81-0.86) and less-frequent treatment intensification (treatment intensification: 20.9% vs 28.6%; OR = 0.71, 95% CI = 0.67-0.76), even after controlling for patient-level characteristics.Participants with limited life expectancy were less likely than those without to have controlled HbA(1c) levels and to receive treatment intensification, suggesting that providers treat these individuals less aggressively. Quality measurement and performance-based reimbursement systems should acknowledge the different needs of this population.

    View details for DOI 10.1111/j.1532-5415.2011.03784.x

    View details for Web of Science ID 000300677400001

    View details for PubMedID 22260627

  • Formal selection of measures for a composite index of NICU quality of care: Baby-MONITOR JOURNAL OF PERINATOLOGY Profit, J., Gould, J. B., Zupancic, J. A., Stark, A. R., WALL, K. M., Kowalkowski, M. A., Mei, M., Pietz, K., Thomas, E. J., Petersen, L. A. 2011; 31 (11): 702-710

    Abstract

    To systematically rate measures of care quality for very low birth weight infants for inclusion into Baby-MONITOR, a composite indicator of quality.Modified Delphi expert panelist process including electronic surveys and telephone conferences. Panelists considered 28 standard neonatal intensive care unit (NICU) quality measures and rated each on a 9-point scale taking into account pre-defined measure characteristics. In addition, panelists grouped measures into six domains of quality. We selected measures by testing for rater agreement using an accepted method.Of 28 measures considered, 13 had median ratings in the high range (7 to 9). Of these, 9 met the criteria for inclusion in the composite: antenatal steroids (median (interquartile range)) 9(0), timely retinopathy of prematurity exam 9(0), late onset sepsis 9(1), hypothermia on admission 8(1), pneumothorax 8(2), growth velocity 8(2), oxygen at 36 weeks postmenstrual age 7(2), any human milk feeding at discharge 7(2) and in-hospital mortality 7(2). Among the measures selected for the composite, the domains of quality most frequently represented included effectiveness (40%) and safety (30%).A panel of experts selected 9 of 28 routinely reported quality measures for inclusion in a composite indicator. Panelists also set an agenda for future research to close knowledge gaps for quality measures not selected for the Baby-MONITOR.

    View details for DOI 10.1038/jp.2011.12

    View details for Web of Science ID 000296590600003

    View details for PubMedID 21350429

  • Clinical Benefits, Costs, and Cost-Effectiveness of Neonatal Intensive Care in Mexico PLOS MEDICINE Profit, J., Lee, D., Zupancic, J. A., Papile, L., Gutierrez, C., Goldie, S. J., Gonzalez-Pier, E., Salomon, J. A. 2010; 7 (12)

    Abstract

    Neonatal intensive care improves survival, but is associated with high costs and disability amongst survivors. Recent health reform in Mexico launched a new subsidized insurance program, necessitating informed choices on the different interventions that might be covered by the program, including neonatal intensive care. The purpose of this study was to estimate the clinical outcomes, costs, and cost-effectiveness of neonatal intensive care in Mexico.A cost-effectiveness analysis was conducted using a decision analytic model of health and economic outcomes following preterm birth. Model parameters governing health outcomes were estimated from Mexican vital registration and hospital discharge databases, supplemented with meta-analyses and systematic reviews from the published literature. Costs were estimated on the basis of data provided by the Ministry of Health in Mexico and World Health Organization price lists, supplemented with published studies from other countries as needed. The model estimated changes in clinical outcomes, life expectancy, disability-free life expectancy, lifetime costs, disability-adjusted life years (DALYs), and incremental cost-effectiveness ratios (ICERs) for neonatal intensive care compared to no intensive care. Uncertainty around the results was characterized using one-way sensitivity analyses and a multivariate probabilistic sensitivity analysis. In the base-case analysis, neonatal intensive care for infants born at 24-26, 27-29, and 30-33 weeks gestational age prolonged life expectancy by 28, 43, and 34 years and averted 9, 15, and 12 DALYs, at incremental costs per infant of US$11,400, US$9,500, and US$3,000, respectively, compared to an alternative of no intensive care. The ICERs of neonatal intensive care at 24-26, 27-29, and 30-33 weeks were US$1,200, US$650, and US$240, per DALY averted, respectively. The findings were robust to variation in parameter values over wide ranges in sensitivity analyses.Incremental cost-effectiveness ratios for neonatal intensive care imply very high value for money on the basis of conventional benchmarks for cost-effectiveness analysis. Please see later in the article for the Editors' Summary.

    View details for DOI 10.1371/journal.pmed.1000379

    View details for Web of Science ID 000285499600006

    View details for PubMedID 21179496

  • Improving benchmarking by using an explicit framework for the development of composite indicators: an example using pediatric quality of care IMPLEMENTATION SCIENCE Profit, J., Typpo, K. V., Hysong, S. J., Woodard, L. D., Kallen, M. A., Petersen, L. A. 2010; 5

    Abstract

    The measurement of healthcare provider performance is becoming more widespread. Physicians have been guarded about performance measurement, in part because the methodology for comparative measurement of care quality is underdeveloped. Comprehensive quality improvement will require comprehensive measurement, implying the aggregation of multiple quality metrics into composite indicators.To present a conceptual framework to develop comprehensive, robust, and transparent composite indicators of pediatric care quality, and to highlight aspects specific to quality measurement in children.We reviewed the scientific literature on composite indicator development, health systems, and quality measurement in the pediatric healthcare setting. Frameworks were selected for explicitness and applicability to a hospital-based measurement system.We synthesized various frameworks into a comprehensive model for the development of composite indicators of quality of care. Among its key premises, the model proposes identifying structural, process, and outcome metrics for each of the Institute of Medicine's six domains of quality (safety, effectiveness, efficiency, patient-centeredness, timeliness, and equity) and presents a step-by-step framework for embedding the quality of care measurement model into composite indicator development.The framework presented offers researchers an explicit path to composite indicator development. Without a scientifically robust and comprehensive approach to measurement of the quality of healthcare, performance measurement will ultimately fail to achieve its quality improvement goals.

    View details for DOI 10.1186/1748-5908-5-13

    View details for Web of Science ID 000275430000001

    View details for PubMedID 20181129

  • Patient-to-Nurse Ratios and Outcomes of Moderately Preterm Infants PEDIATRICS Profit, J., Petersen, L. A., McCormick, M. C., Escobar, G. J., Coleman-Phox, K., Zheng, Z., Pietz, K., Zupancic, J. A. 2010; 125 (2): 320-326

    Abstract

    Moderately preterm infants (30-34(6/7) weeks' gestational age) represent the largest population of NICU residents. Whether their clinical outcomes are associated with differences in NICU nurse-staffing arrangements has not been assessed. The objective of this study was to test the influence of patient-to-nurse ratios (PNRs) on outcomes of care provided to moderately preterm infants.Using data from a prospective, multicenter, observational cohort study of 850 moderately preterm infants from 10 NICUs in California and Massachusetts, we tested for associations between PNR and several important clinical outcomes by using multivariate random-effects models. To correct for the influence of NICU size, we dichotomized the sample into those with an average daily census of <20 or > or =20 infants.Overall, we found few clinically significant associations between PNR and clinical outcomes of care. Mean PNRs were higher in large compared with small NICUs (2.7 vs 2.1; P < .001). In bivariate analyses, an increase in PNR was associated with a slightly higher daily weight gain (5 g/day), greater gestational age at discharge, any intraventricular hemorrhage, and severe retinopathy of prematurity. After controlling for case mix, NICU size, and site of care, an additional patient per nurse was associated with a decrease in daily weight gain by 24%. Other variables were no longer independently associated with PNR.In this population of moderately preterm infants, the PNR was associated with a decrease in daily weight gain, but was not associated with other measures of quality. In contrast with findings in the adult intensive care literature, measured clinical outcomes were similar across the range of nurse-staffing arrangements among participating NICUs. We conclude that the PNR is not useful for profiling hospitals' quality of care delivery to moderately preterm infants.

    View details for DOI 10.1542/peds.2008-3140

    View details for Web of Science ID 000275942900017

    View details for PubMedID 20064868

  • Delayed Pediatric Office Follow-up of Newborns After Birth Hospitalization PEDIATRICS Profit, J., Cambric-Hargrove, A. J., Tittle, K. O., Pietz, K., Stark, A. R. 2009; 124 (2): 548-554

    Abstract

    Key recommendations of the American Academy of Pediatrics guideline on management of severe hyperbilirubinemia in healthy infants of >or=35 weeks' gestation include predischarge screening for risk of subsequent hyperbilirubinemia, follow-up at 3 to 5 days of age, and lactation support. Little information is available on contemporary compliance with follow-up recommendations.To assess timing and content of the first newborn office visit after birth hospitalization in urban and suburban pediatric practices in Houston, Texas.We reviewed office records for the first visit within 4 weeks of birth during January through July 2006 for apparently healthy newborns with a gestational age of >or=35 weeks or birth weight of >or=2500 g seen within a pediatric provider network. For each pediatrician, we selected every fifth patient up to a total of 6.Of 845 records abstracted, 698 (83%) were eligible for analysis. Infants were seen by 136 pediatricians in 39 practices. They had vaginal (64%) or cesarean (36%) deliveries at 20 local hospitals, of which 17 had routine predischarge bilirubin screening policies. Only 37% of all infants, 44% of vaginally delivered infants, and 41% of exclusively breastfed infants were seen before 6 days of age. Thirty-five percent of the infants were seen after 10 days of age. Among 636 infants seen at

    View details for DOI 10.1542/peds.2008-2926

    View details for Web of Science ID 000268377000015

    View details for PubMedID 19651578

  • Pay for performance is growing up ARCHIVES OF PEDIATRICS & ADOLESCENT MEDICINE Profit, J., Petersen, L. A. 2007; 161 (7): 713-714

    View details for Web of Science ID 000247699000016

    View details for PubMedID 17606837

  • Implementing pay-for-performance in the neonatal intensive care unit PEDIATRICS Profit, J., Zupancic, J. A., Gould, J. B., Petersen, L. A. 2007; 119 (5): 975-982

    Abstract

    Pay-for-performance initiatives in medicine are proliferating rapidly. Neonatal intensive care is a likely target for these efforts because of the high cost, available databases, and relative strength of evidence for at least some measures of quality. Pay-for-performance may improve patient care but requires valid measurements of quality to ensure that financial incentives truly support superior performance. Given the existing uncertainty with respect to both the effectiveness of pay-for-performance and the state of quality measurement science, experimentation with pay-for-performance initiatives should proceed with caution and in controlled settings. In this article, we describe approaches to measuring quality and implementing pay-for-performance in the NICU setting.

    View details for DOI 10.1542/peds.2006-1565

    View details for Web of Science ID 000246153300014

    View details for PubMedID 17473099

  • Neonatal intensive care unit census influences discharge of moderately preterm infants PEDIATRICS Profit, J., McCormick, M. C., Escobar, G. J., Richardson, D. K., Zheng, Z., Coleman-Phox, K., Roberts, R., Zupancic, J. A. 2007; 119 (2): 314-319

    Abstract

    The timely discharge of moderately premature infants has important economic implications. The decision to discharge should occur independent of unit census. We evaluated the impact of unit census on the decision to discharge moderately preterm infants.In a prospective multicenter cohort study, we enrolled 850 infants born between 30 and 34 weeks' gestation at 10 NICUs in Massachusetts and California. We divided the daily census from each hospital into quintiles and tested whether discharges were evenly distributed among them. Using logistic regression, we analyzed predictors of discharge within census quintiles associated with a greater- or less-than-expected likelihood of discharge. We then explored parental satisfaction and postdischarge resource consumption in relation to discharge during census periods that were associated with high proportions of discharge.There was a significant correlation between unit census and likelihood of discharge. When unit census was in the lowest quintile, patients were 20% less likely to be discharged when compared with all of the other quintiles of unit census. In the lowest quintile of unit census, patient/nurse ratio was the only variable associated with discharge. When census was in the highest quintile, patients were 32% more likely to be discharged when compared with all of the other quintiles of unit census. For patients in this quintile, a higher patient/nurse ratio increased the likelihood of discharge. Conversely, infants with prolonged lengths of stay, an increasing Score for Neonatal Acute Physiology II, and minor congenital anomalies were less likely to be discharged. Infants discharged at high unit census did not differ from their peers in terms of parental satisfaction, emergency department visits, home nurse visits, or rehospitalization rates.Discharges are closely correlated with unit census. Providers incorporate demand and case mix into their discharge decisions.

    View details for DOI 10.1542/peds.2005-2909

    View details for Web of Science ID 000243942000011

    View details for PubMedID 17272621

  • Moderately premature infants at Kaiser Permanente Medical Care Program in California are discharged home earlier than their peers in Massachusetts and the United Kingdom ARCHIVES OF DISEASE IN CHILDHOOD-FETAL AND NEONATAL EDITION Profit, J., Zupancic, J. A., McCormick, M. C., Richardson, D. K., Escobar, G. J., Tucker, J., Tarnow-Mordi, W., Parry, G. 2006; 91 (4): F245-F250

    Abstract

    To compare gestational age at discharge between infants born at 30-34(+6) weeks gestational age who were admitted to neonatal intensive care units (NICUs) in California, Massachusetts, and the United Kingdom.Prospective observational cohort study.Fifty four United Kingdom, five California, and five Massachusetts NICUs.A total of 4359 infants who survived to discharge home after admission to an NICU.Gestational age at discharge home.The mean (SD) postmenstrual age at discharge of the infants in California, Massachusetts, and the United Kingdom were 35.9 (1.3), 36.3 (1.3), and 36.3 (1.9) weeks respectively (p = 0.001). Compared with the United Kingdom, adjusted discharge of infants occurred 3.9 (95% confidence interval (CI) 1.4 to 6.5) days earlier in California, and 0.9 (95% CI -1.2 to 3.0) days earlier in Massachusetts.Infants of 30-34(+6) weeks gestation at birth admitted and cared for in hospitals in California have a shorter length of stay than those in the United Kingdom. Certain characteristics of the integrated healthcare approach pursued by the health maintenance organisation of the NICUs in California may foster earlier discharge. The California system may provide opportunities for identifying practices for reducing the length of stay of moderately premature infants.

    View details for DOI 10.1136/adc.2005.075093

    View details for Web of Science ID 000238845800003

    View details for PubMedID 16449257

Presentations


  • Chef Stan Dard and Mu Siq Team Up to Deliver Delicious Fare

    Summary report of NICQ 8 Nutrition Homeroom quality improvement accomplishments in the areas of care context improvement and care standardization.

    Time Period

    October 4, 2013

    Presented To

    Vermont Oxford Network NICQ 8 Collaborative, Plenary

    Location

    Chicago, IL

  • Changing Incentives in Health Care: Getting Ready for ObamaCare

    Keynote Speaker, Annual Dr. Margaret I. Handy Memorial Lectureship

    Time Period

    September 17, 2013

    Presented To

    Christiana Care Health System

    Location

    Newark, DE

  • Patient Safety Culture in the NICU

    Keynote Speaker, Annual Dr. Margaret I. Handy Memorial Lectureship

    Time Period

    September 17, 2013

    Presented To

    Christiana Care Health System

    Location

    Newark, DE

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