Benchmarking in health care has the potential to uncover unwarranted variation between health care providers in effective care, preference sensitive care and supply sensitive care. Correctly implemented, collaboration between the assessed providers will lead to improved care, lower costs and stronger adherence to patient preferences.
This thesis describes how the Swiss Neonatal Network (SwissNeoNet) developed and implemented its benchmarking concept among the Swiss neonatal intensive care units (NICUs), how it uncovered unwarranted variation in processes such as antenatal steroids and outcomes such as late onset sepsis, and thereby fostered the formation of a long lasting, open, national collaboration among Swiss NICUs. Locally implemented improvement projects emerged as a result. At its core, SwissNeoNet operates an online platform with which the NICUs can monitor their annual performance based on relevant, scientifically sound and feasible quality indicators. Continuously updated, dynamic longitudinal and crosssectional charts were designed for uncovering unwarranted variation.
As local monitoring does not afford assurance on the overall quality of Swiss performance, international reference data was sought by collaborating with the International Network for Evaluating Outcomes (iNEO). Compared with this group of national neonatal networks, Switzerland demonstrates comparable survival rates with a potential to improve at 24- and 25-weeks' gestation, as well as markedly lower incidences of major morbidities such as bronchopulmonary dysplasia (BPD) and retinopathy of prematurity (ROP). Limitations of international benchmarking center on comparability of cohorts with respect to item definitions and population coverage, and in proof of effectiveness, for which however evidence is emerging.
Lastly, this thesis reveals how international benchmarking can lead to novel ideas on how to optimize care. In this thesis, I describe how the low incidence of ROP was first critically tested and verified locally and subsequently led to a proposal on how to reduce efforts for screening. We present a risk model with which ROP screening can theoretically be applied to less than 15% of the original cohort of newborn infants and thus lead to fewer infants undergoing an arduous set of examinations, and to reduction in health care expenditure.