A Clinical Pathway for Bronchiolitis is Effective in Reducing Readmission Rates

Cheney, Joyce; Barber, Scott; Altamirano, Luis; Medico∼Cirujano,; Cheney, Marise; Williams, Chris; Jackson, Mary Anne; Yates, Patsy; O’Rourke, Peter; Wainwright, Claire

doi:10.1016/j.jpeds.2005.06.040

Cited by 60 publications

(53 citation statements)

References 9 publications

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“…If a combined readmissions measure for common diseases was adopted, potential interventions could focus on delivering guideline-recommended care across similar diseases. Previous studies implementing care pathways and improving compliance with guidelines have reduced pediatric readmissions for bronchiolitis 35 and asthma, 36 although other studies have not shown improvements, 8,37 and thus additional work remains to be done. A pooled measure of readmissions for hospitals that admit a large number of complex chronically ill children, 38 who are known to be at risk for frequent readmissions, 2,3 could focus improvements specifically on these children during their transitions of care.…”

Section: Discussionmentioning

confidence: 99%

Measuring Hospital Quality Using Pediatric Readmission and Revisit Rates

Bardach¹,

et al. 2013

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WHAT'S KNOWN ON THIS SUBJECT: Readmissions have been identified as a priority area for pediatric inpatient quality measurement nationally. However, it is unknown whether readmission rates vary meaningfully across hospitals and how many hospitals would be identified as high-or low-performers. WHAT THIS STUDY ADDS:Only a few hospitals that care for children are high-or low-performers when their conditionspecific revisit rates are compared with average rates across hospitals. This limits the usefulness of condition-specific readmission or revisit measures in pediatric quality measurement. abstract OBJECTIVE: To assess variation among hospitals on pediatric readmission and revisit rates and to determine the number of high-and low-performing hospitals. METHODS:In a retrospective analysis using the State Inpatient and Emergency Department Databases from the Healthcare Cost and Utilization Project with revisit linkages available, we identified pediatric (ages 1-20 years) visits with 1 of 7 common inpatient pediatric conditions (asthma, dehydration, pneumonia, appendicitis, skin infections, mood disorders, and epilepsy). For each condition, we calculated rates of all-cause readmissions and rates of revisits (readmission or presentation to the emergency department) within 30 and 60 days of discharge. We used mixed logistic models to estimate hospital-level riskstandardized 30-day revisit rates and to identify hospitals that had performance statistically different from the group mean.RESULTS: Thirty-day readmission rates were low (,10.0%) for all conditions. Thirty-day rates of revisit to the inpatient or emergency department setting ranged from 6.2% (appendicitis) to 11.0% (mood disorders). Study hospitals (n = 958) had low condition-specific visit volumes (37.0%-82.8% of hospitals had ,25 visits). The only condition with .1% of hospitals labeled as different from the mean on 30-day risk-standardized revisit rates was mood disorders (4.2% of hospitals [n = 15], range of hospital performance 6.3%-15.9%). CONCLUSIONS:We found that when comparing hospitals' performances to the average, few hospitals that care for children are identified as high-or low-performers for revisits, even for common pediatric diagnoses, likely due to low hospital volumes. This limits the usefulness of condition-specific readmission or revisit measures in pediatric quality measurement. Pediatrics 2013;132:429-436

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Section: Discussionmentioning

confidence: 99%

Measuring Hospital Quality Using Pediatric Readmission and Revisit Rates

Bardach¹,

et al. 2013

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“…Only 3 studies used some form of external control. 29,30,34 The lack of control subjects in before-and-after studies raises concerns that the change reported could have been due to secular trends rather than the intervention described. All studies did well on evaluation of whether the before-and-after study population shared similar characteristics.…”

Section: Methodologic Qualitymentioning

confidence: 99%

“…The characteristics of the 14 studies [25][26][27][28][29][30][31][32][33][34][35][36][37][38] in this review are described in Table 1, including our qualitative assessment of the categorical type of intervention (described later in further detail): primarily educational (providing voluntary guidelines, presenting conferences); involving significant process change (implementing standardized order sets); and involving significant process change plus the use of a respiratory score. A respiratory score was loosely defined as any multicomponent numerical representation of respiratory effort.…”

Section: Included Studiesmentioning

confidence: 99%

“…No individual study reported a negative impact on readmission rates, and 2 studies reported a statistically significant positive impact of the intervention. 27,34 Costs were analyzed in 4 studies, all using differing methods. Four studies reported decreased charges or costs associated with the intervention, 26,27,30,36 and 1 study reported no change.…”

Section: Harms/balancing Measuresmentioning

confidence: 99%

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Effectiveness of Quality Improvement in Hospitalization for Bronchiolitis: A Systematic Review

et al. 2014

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BACKGROUND: Bronchiolitis causes nearly 20% of all acute care hospitalizations for young children in the United States. Unnecessary testing and medication for infants with bronchiolitis contribute to cost without improving outcomes. OBJECTIVES:The goal of this study was to systematically review the quality improvement (QI) literature on inpatient bronchiolitis and to propose benchmarks for reducing unnecessary care. METHODS:Assisted by a medical librarian, we searched Medline, Cumulative Index to Nursing and Allied Health Literature, and the Cochrane Library. Studies describing any active QI intervention versus usual care in hospitalized children ,2 years of age were included. Data were extracted and confirmed by multiple investigators and pooled by using a random effects model. Benchmarks were calculated by using achievable benchmarks of care methods. RESULTS:Fourteen studies involving .12 000 infants were reviewed. QI interventions resulted in 16 fewer patients exposed to repeated doses of bronchodilators per 100 hospitalized (7 studies) (risk difference: 0.16 [95% confidence interval: 0.11-0.21]) and resulted in 5.3 fewer doses of bronchodilator given per patient (95% confidence interval: 2

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“…4 At the hospital level, many institutions have implemented interventions such as clinical pathways or practice guidelines to improve care for children hospitalized for respiratory illnesses. [5][6][7][8][9] However, such interventions require substantial commitment of resources toward development, implementation, and maintenance. 10 Ideally, interventions to improve care should be targeted toward high-risk patients or hospitals.…”

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confidence: 99%

Risk Factors for Prolonged Length of Stay or Complications During Pediatric Respiratory Hospitalizations

Kaiser

Bakel

Okumura

et al. 2015

Hospital Pediatrics

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A B S T R A C T BACKGROUND AND OBJECTIVES:Respiratory illnesses are the leading cause of pediatric hospitalizations in the United States, and a major focus of efforts to improve quality of care. Understanding factors associated with poor outcomes will allow better targeting of interventions for improving care. The objective of this study was to identify patient and hospital factors associated with prolonged length of stay (LOS) or complications during pediatric hospitalizations for asthma or lower respiratory infection (LRI). METHODS:Cross-sectional study of hospitalizations of patients ,18 years with asthma or LRI (bronchiolitis, influenza, or pneumonia) by using the nationally representative 2012 Kids Inpatient Database. We used multivariable logistic regression models to identify factors associated with prolonged LOS (.90th percentile) or complications (noninvasive ventilation, mechanical ventilation, or death). CONCLUSIONS: Older children with asthma, younger children with LRI, children with chronic conditions, and those hospitalized in large urban-teaching hospitals are more vulnerable to prolonged LOS and complications. Future research and policy efforts should evaluate and support interventions to improve outcomes for these high-risk groups (eg, hospital-based care coordination for children with chronic conditions). RESULTS:

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A Clinical Pathway for Bronchiolitis is Effective in Reducing Readmission Rates

Abstract: A clinical pathway specifying local practice guidelines and discharge criteria can reduce the risk of readmission to hospital, the use of inappropriate therapies, and help with discharge planning.

Cited by 60 publications

References 9 publications

Measuring Hospital Quality Using Pediatric Readmission and Revisit Rates

Measuring Hospital Quality Using Pediatric Readmission and Revisit Rates

Effectiveness of Quality Improvement in Hospitalization for Bronchiolitis: A Systematic Review

Risk Factors for Prolonged Length of Stay or Complications During Pediatric Respiratory Hospitalizations

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