Quality-of-Care Indicators for the Neurodevelopmental Follow-Up of Very Low Birth Weight Children

Results of an Expert Panel Process

Annually, 40,000 babies are born that weigh less than 1500g. These babies, categorized as very low birth weight (VLBW), experience a variety of medical problems. However, few (if any) studies exist documenting the follow-up care these patients receive. Documenting quality of care has been shown to lead to improved care in other areas of medicine, such as cardiac disease. This research attempts to develop a set of quality-of-care indicators for VLBW patients.

The authors reviewed 437 articles related to VLBW issues, as well as clinical practice guidelines, and then selected a set of potential quality-of-care indicators. They asked a 10-member panel to rate the indicators for validity and feasibility, based on several factors. After a round of discussion, the panelists re-rated the revised list of indicators. After further discussions, the authors established a final set of 70 indicators to guide neurodevelopmental follow-up. The authors expressed surprise that no such guidelines existed previously, particularly given the large proportion of VLBW children that are enrolled in Medicaid. Medicaid patients have been found to receive worse care than children enrolled in commercial health care programs.

The authors emphasize that, as stronger clinical evidence for follow-up care becomes available, their initial set of indicators should be revised based on that evidence. In the meantime, however, researchers can use this set of indicators to measure the quality of follow-up care now being provided to VLBW infants and children.