Trial reportBMJ (Clinical research ed.)2004
Collaborative quality improvement to promote evidence based surfactant for preterm infants: a cluster randomised trial.
Trial report in BMJ (Clinical research ed.), 2004. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 58 papers, 8 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
58 citing papers in PubMed, 8 syntheses or guidelines pooled it.
- Audit and feedback: effects on professional practice.The Cochrane database of systematic reviews · 2025Pooled it
- Pooled it
- The effectiveness of continuous quality improvement for developing professional practice and improving health care outcomes: a systematic review.Implementation science : IS · 2020Pooled it
- Tools developed and disseminated by guideline producers to promote the uptake of their guidelines.The Cochrane database of systematic reviews · 2016Pooled it
- Understanding the components of quality improvement collaboratives: a systematic literature review.The Milbank quarterly · 2013Pooled it
- Audit and feedback: effects on professional practice and healthcare outcomes.The Cochrane database of systematic reviews · 2012Pooled it
- Patient isolation measures for infants with candida colonization or infection for preventing or reducing transmission of candida in neonatal units.The Cochrane database of systematic reviews · 2011Pooled it
- What is the empirical evidence that hospitals with higher-risk adjusted mortality rates provide poorer quality care? A systematic review of the literature.BMC health services research · 2007Pooled it
- Trial
- Effect of Needle Aspiration of Pneumothorax on Subsequent Chest Drain Insertion in Newborns: A Randomized Clinical Trial.JAMA pediatrics · 2018Trial
- Trial
- Evaluating the effectiveness of a tailored multifaceted performance feedback intervention to improve the quality of care: protocol for a cluster randomized trial in intensive care.Implementation science : IS · 2011Trial
- Complications among premature neonates treated with beractant and poractant alfa.Indian journal of pediatrics · 2010Trial
- Improving the quality of care for infants: a cluster randomized controlled trial.CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2009Trial
- Outcomes for Very Preterm Infants Across Health Systems.JAMA network open · 2025Article
- Effect of a multifaceted intervention with audit and feedback on low-risk childbirth practice: a multicentre prospective study.BMC pregnancy and childbirth · 2025Article
- How consistent are the key recommendations, and what is the quality of guidelines and expert consensus regarding paediatric cow's milk protein allergy?European journal of pediatrics · 2024Article
- Review
- The challenges of keeping clinicians unaware of their participation in a national, cluster-randomised, implementation trial.BMC medical ethics · 2022Article
- A typology of useful evidence: approaches to increase the practical value of intervention research.BMC medical research methodology · 2020Article
Corrections and comments
- Commented on by
Authors and funding
9 authors.
Funding
Abstract
objectiveTo test a multifaceted collaborative quality improvement intervention designed to promote evidence based surfactant treatment for preterm infants of 23-29 weeks' gestation.
designCluster randomised controlled trial. SETTING AND
participants114 neonatal intensive care units (which treated 6039 infants of 23-29 weeks gestation born in 2001).
main outcome measuresProcess of care measures: proportion of infants receiving first surfactant in the delivery room, proportion receiving first surfactant more than two hours after birth, and median time from birth to first dose of surfactant. Clinical outcomes: death before discharge home, and pneumothorax.
interventionMultifaceted collaborative quality improvement advice including audit and feedback, evidence reviews, an interactive training workshop, and ongoing faculty support via conference calls and email.
resultsCompared with those in control hospitals, infants in intervention hospitals were more likely to receive surfactant in the delivery room (adjusted odds ratio 5.38 (95% confidence interval 2.84 to 10.20)), were less likely to receive the first dose more than two hours after birth (adjusted odds ratio 0.35 (0.24 to 0.53)), and received the first dose of surfactant sooner after birth (median of 21 minutes v 78 minutes, P < 0.001). The intervention effect on timing of surfactant was larger for infants born in the participating hospitals than for infants transferred to a participating hospital after birth. There were no significant differences in mortality or pneumothorax.
conclusionA multifaceted intervention including audit and feedback, evidence reviews, quality improvement training, and follow up support changed the behaviour of health professionals and promoted evidence based practice.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.