Also, outcome indicators might indicate the impact of quality improvement efforts. Clinical outcome indicators cannot identify accurately the areas that need improvement, but are highly significant for patients and caregivers and can be used for public scrutiny. Process indicators represent direct quality measures that provide feedback for quality improvement and providers accountability. In clinical practice, evidence-based process of care and clinical outcomes indicators serve to perform comprehensive QoC evaluations. To the best of our knowledge, information on the QoC at NICUs is even more limited in other Latin American countries. Also, heavy workload reflected in the number of discharges per number of nurses, along with the occurrence of unsafe events such as birth trauma or acute renal failure, increased the probability of a neonate dying at NICUs.
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At IMSS hospitals, there is a high incidence of nosocomial infections and diseases secondary to prolonged endotracheal intubation. Available studies have reported deficiencies in the QoC for neonates admitted to MoH NICUs with transient tachypnea and necrotizing enterocolitis. In both Mexican subsystems, research on the QoC for preterm neonates is incipient, and NICUs lack validated indicators to measure the QoC. The Mexican Institute of Social Security (IMSS) is the largest provider of ambulatory and hospital healthcare, covering 60.9% of the Mexican population. The MoH provides healthcare to people without social security, while SSIs provide healthcare to formal sector workers and their families. In Mexico, health professionals attend 99% of deliveries, most of them in public hospitals, in two subsystems: the Ministry of Health (MoH) and Social Security institutions (SSIs). In developing countries, NICUs have wide variability of infrastructure and quality of care (QoC), therefore their evaluation and improvement is relevant. In developed countries, the improvement of newborns survival has been partially attributed to the care that neonatal intensive care units (NICUs) provide. More than three-quarters of premature babies can survive with evidence-based, cost-effective care during delivery, neonatal and post-neonatal periods. Mexico was in the middle, with 5.8 deaths and 2.4 deaths, respectively. Honduras had the highest neonatal mortality (9.2 and 2.6 deaths for the corresponding neonatal periods), and Costa Rica the lowest (3.9 and 1.3 deaths, respectively). In Latin America in 2013, there were 5.8 deaths per 1000 live births (LB) in the early neonatal period (0–6 days) and 2.3 deaths per 1000 LB in the late neonatal period (7–28 days).
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The forecast for 2035 is that ‘there will be an additional 49 million neonatal deaths and 99 million children who will not reach their development potential due to disability after preterm birth’. The toll represents 2.9 million neonatal deaths annually, of which 1.47 million are attributed to preterm birth. Quality of care, preterm newborns, neonatal intensive care units, Mexico BackgroundĪlmost half of under-five child deaths worldwide occur within the first 28 days after birth.