Integral assessment of the quality of medical care in Neonatal Intensive Care Units financed by the Health Insurance for a New Generation of Mexico

Background. At the request of the program "Medical Insurance for a New Generation in Mexico" (SMNG), we evaluated the quality of care provided to infants with respiratory distress syndrome (RDS) in the neonatal intensive care unit (NICU) financed by SMNG. Methods. There were 22 NICUs that were evaluated, with 19 structural indexes, 23 medical staff personnel, and 37 processes and outcomes measured by the mortality of RDS. The indexes were validated and qualified with the Likert metric or dichotomous scale. The average score of the qualifications were categorized as: "good" between 85 and 100 points, "average" between 60 and 84 points and "poor" < 59 points. RDS as a tracer condition was evaluated from the birth of the newborn in level I or II NICU, during transportation and during hospital stay at level III. Results. Below are some indexes in the "poor" categories in the following components: structure, 11 without gasometer in the NICU and eight in the supply of essential drugs. For medical staff, in 22 NICUs the staff had not read a medical article during the last month, and 17 staff members do not use evidence-based medicine. According to processes, 13 NICU (level I or II) did not administer surfactant to infants, in nine NICU they did not perform blood gas analysis, 12 physicians did not accompany the neonate during transport and several infants arrived at level III NICU with hypothermia. The latter were categorized as "poor" according to several aspects related to the administration of surfactant and in terms of mortality as the result component was higher at lower total score indexes. Conclusions. The quality of care was poor or average in many NICUs, from the time of birth, during transportation and during the newborn's stay in Level III NICU.