{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,19]],"date-time":"2026-04-19T12:27:11Z","timestamp":1776601631973,"version":"3.51.2"},"reference-count":16,"publisher":"Walter de Gruyter GmbH","issue":"3","funder":[{"DOI":"10.13039\/100000097","name":"National Center for Research Resources","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100000097","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100006108","name":"National Center for Advancing Translational Sciences","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100006108","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"crossref","award":["UL1TR001436"],"award-info":[{"award-number":["UL1TR001436"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100008980","name":"Medical College of Wisconsin","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100008980","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,3,26]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec id=\"j_jpm-2020-0095_abs_001\">\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>Therapeutic hypothermia is an effective neuroprotective intervention for infants with moderate or severe hypoxic-ischemic encephalopathy (HIE). With the introduction of new medical therapy comes a learning curve with regards to its proper implementation and understanding of eligibility guidelines. We hypothesized that variation in patient selection and lack of adherence to established protocols contributed to the utilization drift away from the original eligibility guidelines.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec id=\"j_jpm-2020-0095_abs_002\">\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>A retrospective cohort study was conducted including infants who received therapeutic hypothermia in the neonatal intensive care unit (NICU) for HIE to determine utilization drift. We then used QI methodology to address gaps in medical documentation that may lead to the conclusion that therapeutic hypothermia was inappropriately applied.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec id=\"j_jpm-2020-0095_abs_003\">\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>We identified 54% of infants who received therapeutic hypothermia who did not meet the clinical, physiologic, and neurologic examination criteria for this intervention based on provider admission and discharge documentation within the electronic medical record (EMR). Review of the charts identified incomplete documentation in 71% of cases and led to the following interventions: 1) implementation of EMR smartphrases; 2) engagement of key stakeholders and education of faculty, residents, and neonatal nurse practitioners; and 3) performance measurement and sharing of data. We were able to improve both adherence to the therapeutic hypothermia guidelines and achieve 100% documentation of the modified Sarnat score.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec id=\"j_jpm-2020-0095_abs_004\">\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Incomplete documentation can lead to the assumption that therapeutic hypothermia was inappropriately applied when reviewing a patient\u2019s EMR. However, in actual clinical practice physicians follow the clinical guidelines but are not documenting their medical decision making completely. QI methodology addresses this gap in documentation, which will help determine the true utilization drift of therapeutic hypothermia in future studies.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1515\/jpm-2020-0095","type":"journal-article","created":{"date-parts":[[2020,11,17]],"date-time":"2020-11-17T08:03:54Z","timestamp":1605600234000},"page":"389-395","source":"Crossref","is-referenced-by-count":11,"title":["Quality improvement for reducing utilization drift in hypoxic-ischemic encephalopathy management"],"prefix":"10.1515","volume":"49","author":[{"given":"Katherine","family":"Carlton","sequence":"first","affiliation":[{"name":"Medical College of Wisconsin , Pediatrics , Milwaukee , Wisconsin , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Erwin","family":"Cabacungan","sequence":"additional","affiliation":[{"name":"Medical College of Wisconsin , Pediatrics , Milwaukee , Wisconsin , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Samuel J.","family":"Adams","sequence":"additional","affiliation":[{"name":"Medical College of Wisconsin , Neurology , Milwaukee , Wisconsin , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4444-2145","authenticated-orcid":false,"given":"Susan S.","family":"Cohen","sequence":"additional","affiliation":[{"name":"Medical College of Wisconsin , Pediatrics , 999 N. 92nd Street, CCC 410, Milwaukee, 53226-0509 , Milwaukee , Wisconsin , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"374","published-online":{"date-parts":[[2020,11,3]]},"reference":[{"key":"2023092212122972428_j_jpm-2020-0095_ref_001","doi-asserted-by":"crossref","unstructured":"Gagne-Loranger, M, Sheppard, M, Ali, N, Saint-Martin, C, Wintermark, P. Newborns referred for therapeutic hypothermia: association between initial degree of encephalopathy and severity of brain injury (what about the newborns with mild encephalopathy on admission?) Am J Perinatol 2016;33:195\u2013202. https:\/\/doi.org\/10.1055\/s-0035-1563712.","DOI":"10.1055\/s-0035-1563712"},{"key":"2023092212122972428_j_jpm-2020-0095_ref_002","doi-asserted-by":"crossref","unstructured":"Herrera, TI, Edwards, L, Malcolm, WF, Smith, PB, Fisher, KA, Pizoli, C, et al.. Outcomes of preterm infants treated with hypothermia for hypoxic-ischemic encephalopathy. Early Hum Dev 2018;125:1\u20137. https:\/\/doi.org\/10.1016\/j.earlhumdev.2018.08.003.","DOI":"10.1016\/j.earlhumdev.2018.08.003"},{"key":"2023092212122972428_j_jpm-2020-0095_ref_003","doi-asserted-by":"crossref","unstructured":"Jacobs, SE, Berg, M, Hunt, R, Tarnow-Mordi, WO, Inder, TE, Davis, PG. Cooling for newborns with hypoxic ischaemic encephalopathy. Cochrane Database Syst Rev 2013;1. CD003311. https:\/\/doi.org\/10.1002\/14651858.CD003311.pub3.","DOI":"10.1002\/14651858.CD003311.pub3"},{"key":"2023092212122972428_j_jpm-2020-0095_ref_004","doi-asserted-by":"crossref","unstructured":"Jacobs, SE, Morley, CJ, Inder, TE, Stewart, MJ, Smith, KR, McNamara, PJ, et al.. Whole-body hypothermia for term and near-term newborns with hypoxic-ischemic encephalopathy: a randomized controlled trial. Arch Pediatr Adolesc Med 2011;165:692\u2013700. https:\/\/doi.org\/10.1001\/archpediatrics.2011.43.","DOI":"10.1001\/archpediatrics.2011.43"},{"key":"2023092212122972428_j_jpm-2020-0095_ref_005","doi-asserted-by":"crossref","unstructured":"Shankaran, S, Laptook, AR, Ehrenkranz, RA, Tyson, JE, McDonald, SA, Donovan, EF, et al.. Whole-body hypothermia for neonates with hypoxic-ischemic encephalopathy. N Engl J Med 2005;353:1574\u201384. https:\/\/doi.org\/10.1056\/nejmcps050929.","DOI":"10.1056\/NEJMcps050929"},{"key":"2023092212122972428_j_jpm-2020-0095_ref_006","doi-asserted-by":"crossref","unstructured":"Wyatt, JS, Gluckman, PD, Liu, PY, Azzopardi, D, Ballard, R, Edwards, AD, et al.. Determinants of outcomes after head cooling for neonatal encephalopathy. Pediatrics 2007;119:912\u201321. https:\/\/doi.org\/10.1542\/peds.2006-2839.","DOI":"10.1542\/peds.2006-2839"},{"key":"2023092212122972428_j_jpm-2020-0095_ref_007","doi-asserted-by":"crossref","unstructured":"Kurinczuk, JJ, White-Koning, M, Badawi, N. Epidemiology of neonatal encephalopathy and hypoxic-ischaemic encephalopathy. Early Hum Dev 2010;86:329\u201338. https:\/\/doi.org\/10.1016\/j.earlhumdev.2010.05.010.","DOI":"10.1016\/j.earlhumdev.2010.05.010"},{"key":"2023092212122972428_j_jpm-2020-0095_ref_008","doi-asserted-by":"crossref","unstructured":"Laptook, AR, Shankaran, S, Tyson, JE, Munoz, B, Bell, EF, Goldberg, RN, et al.. Effect of therapeutic hypothermia initiated after 6 hours of age on death or disability among newborns with hypoxic-ischemic encephalopathy: a randomized clinical trial. J Am Med Assoc 2017;318:1550\u201360. https:\/\/doi.org\/10.1001\/jama.2017.14972.","DOI":"10.1001\/jama.2017.14972"},{"key":"2023092212122972428_j_jpm-2020-0095_ref_009","doi-asserted-by":"crossref","unstructured":"McAdams, RM, Juul, SE. Neonatal encephalopathy: update on therapeutic hypothermia and other novel therapeutics. Clin Perinatol 2016;43:485\u2013500. https:\/\/doi.org\/10.1016\/j.clp.2016.04.007.","DOI":"10.1016\/j.clp.2016.04.007"},{"key":"2023092212122972428_j_jpm-2020-0095_ref_010","doi-asserted-by":"crossref","unstructured":"Pfister, RH, Bingham, P, Edwards, EM, Horbar, JD, Kenny, MJ, Inder, T, et al.. The Vermont Oxford Neonatal Encephalopathy Registry: rationale, methods, and initial results. BMC Pediatr 2012;12:84. https:\/\/doi.org\/10.1186\/1471-2431-12-84.","DOI":"10.1186\/1471-2431-12-84"},{"key":"2023092212122972428_j_jpm-2020-0095_ref_011","doi-asserted-by":"crossref","unstructured":"Prempunpong, C, Chalak, LF, Garfinkle, J, Shah, B, Kalra, V, Rollins, N, et al.. Prospective research on infants with mild encephalopathy: the PRIME study. J Perinatol 2018;38:80\u20135. https:\/\/doi.org\/10.1038\/jp.2017.164.","DOI":"10.1038\/jp.2017.164"},{"key":"2023092212122972428_j_jpm-2020-0095_ref_012","doi-asserted-by":"crossref","unstructured":"Azzopardi, D, Brocklehurst, P, Edwards, D, Halliday, H, Levene, M, Thoresen, M, et al.. The TOBY Study. Whole body hypothermia for the treatment of perinatal asphyxial encephalopathy: a randomised controlled trial. BMC Pediatr 2008;8:17. https:\/\/doi.org\/10.1186\/1471-2431-8-17.","DOI":"10.1186\/1471-2431-8-17"},{"key":"2023092212122972428_j_jpm-2020-0095_ref_013","doi-asserted-by":"crossref","unstructured":"Rao, R, Trivedi, S, Distler, A, Liao, S, Vesoulis, Z, Smyser, C, et al.. Neurodevelopmental outcomes in neonates with mild hypoxic ischemic encephalopathy treated with therapeutic hypothermia. Am J Perinatol 2019;36:1337\u201343. https:\/\/doi.org\/10.1055\/s-0038-1676973.","DOI":"10.1055\/s-0038-1676973"},{"key":"2023092212122972428_j_jpm-2020-0095_ref_014","doi-asserted-by":"crossref","unstructured":"Rao, R, Trivedi, S, Vesoulis, Z, Liao, SM, Smyser, CD, Mathur, AM. Safety and short-term outcomes of therapeutic hypothermia in preterm neonates 34-35 Weeks gestational age with hypoxic-ischemic encephalopathy. J Pediatr 2017;183:37\u201342. https:\/\/doi.org\/10.1016\/j.jpeds.2016.11.019.","DOI":"10.1016\/j.jpeds.2016.11.019"},{"key":"2023092212122972428_j_jpm-2020-0095_ref_015","doi-asserted-by":"crossref","unstructured":"Sarnat, HB, Sarnat, MS. Neonatal encephalopathy following fetal distress. A clinical and electroencephalographic study. Arch Neurol 1976;33:696\u2013705. https:\/\/doi.org\/10.1001\/archneur.1976.00500100030012.","DOI":"10.1001\/archneur.1976.00500100030012"},{"key":"2023092212122972428_j_jpm-2020-0095_ref_016","doi-asserted-by":"crossref","unstructured":"McMillan, D, Wu, J. Approach to the bleeding newborn. Paediatr Child Health 1998;3:399\u2013401. https:\/\/doi.org\/10.1093\/pch\/3.6.399.","DOI":"10.1093\/pch\/3.6.399"}],"container-title":["Journal of Perinatal Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.degruyter.com\/view\/journals\/jpme\/ahead-of-print\/article-10.1515-jpm-2020-0095\/article-10.1515-jpm-2020-0095.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.degruyter.com\/document\/doi\/10.1515\/jpm-2020-0095\/xml","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.degruyter.com\/document\/doi\/10.1515\/jpm-2020-0095\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,22]],"date-time":"2023-09-22T12:14:23Z","timestamp":1695384863000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.degruyter.com\/document\/doi\/10.1515\/jpm-2020-0095\/html"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,11,3]]},"references-count":16,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2020,10,23]]},"published-print":{"date-parts":[[2021,3,26]]}},"alternative-id":["10.1515\/jpm-2020-0095"],"URL":"https:\/\/doi.org\/10.1515\/jpm-2020-0095","relation":{},"ISSN":["0300-5577","1619-3997"],"issn-type":[{"value":"0300-5577","type":"print"},{"value":"1619-3997","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,11,3]]}}}