Association of Bronchiolitis Clinical Pathway Adherence With Length of Stay and Costs

Bryan, Mersine A.; Desai, Arti D.; Wilson, Lauren; Wright, Davene R.; Mangione-Smith, Rita

doi:10.1542/peds.2016-3432

Cited by 46 publications

(54 citation statements)

References 24 publications

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“…(35) More recently, a retrospective study showed how adherence to a standardized clinical pathway in 267 children with bronchiolitis was associated with shorter length of stay in the emergency department (ED), with no significant differences in hospital stay. (36) Contrary to those studies, we found that the implementation of a discharge protocol significantly reduced length of stay with no increase in readmission rates. These discrepancies may be related to differences in the populations included and study design, since thresholds to discontinue supplemental oxygen, acceptable duration without oxygen therapy or admissible oral intake at discharge were not homogeneous or completely addressed.…”

Section: Discussioncontrasting

confidence: 99%

“…Utilization of these pathways have been associated with a reduction on resource utilization (chest-x rays, albuterol or steroid use) with variable results in terms of clinical outcomes. (34–36, 38–40) A study comparing a cohort of 229 infants with bronchiolitis who were managed based on a clinical pathway, with a historical cohort of 207 children managed without the pathway, showed that protocol adherence was associated with decreased readmission rates with no impact on length of hospital stay. (35) More recently, a retrospective study showed how adherence to a standardized clinical pathway in 267 children with bronchiolitis was associated with shorter length of stay in the emergency department (ED), with no significant differences in hospital stay.…”

Section: Discussionmentioning

confidence: 99%

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Discharge Criteria for Bronchiolitis

Garcia-Maurino

Moore‐Clingenpeel

Wallihan

et al. 2018

Pediatric Infectious Disease Journal

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Background: Admission criteria and standardized management strategies for bronchiolitis are addressed in several guidelines and have shown to be beneficial; however, guidance regarding discharge criteria is limited and widely variable. We assessed the impact on clinical outcomes of a discharge protocol for children <2 years of age hospitalized with bronchiolitis in a tertiary care pediatric hospital. Methods: In October 2013, a protocol to standardize the discharge of children with bronchiolitis was implemented in the infectious diseases (ID) ward but not in other pediatric units caring for these children (non-ID). The protocol included objective clinical criteria and a standardized oxygen weaning pathway. Patients were identified via International Classification of Diseases-9 codes and data manually reviewed. We compared length of stay (LOS) and readmission rates within 2 weeks of discharge according to protocol implementation (ID versus non-ID), adjusted for demographic factors, comorbidities, viral etiology and stratified by pediatric intensive care unit admission. Results: From October 2013 to May 2015, 1118 children were hospitalized in ID and 695 in non-ID units. Median age was 4.5 months, 55% were males and 28% had comorbidities. LOS was 36% longer in non-ID units (risk ratio: 1.36 [1.27–1.45]; P < 0.001) adjusted for age, gender, comorbidities and viral etiology. Difference in LOS remained significant after excluding children with comorbidities and stratifying by pediatric intensive care unit admission. Readmission rates were comparable between units (ID, 2.9% versus non-ID, 2.6%). Conclusions: A standardized discharge protocol for bronchiolitis reduced LOS without increasing readmission rates. Unifying bronchiolitis discharge criteria and oxygen weaning pathways could positively impact hospital-based patient care for this condition.

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Discharge Criteria for Bronchiolitis

Garcia-Maurino

Moore‐Clingenpeel

Wallihan

et al. 2018

Pediatric Infectious Disease Journal

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“…In other words, the clinical pathway of the pediatric DHF treatment in the studied hospital was fairly well-implemented. This result corresponds to previous research (Bryan et al, 2017), which confirmed that the number of patients who receive treatments adhering to clinical pathways is significantly higher than in the opposite group.…”

Section: Conformity Of Pediatric Dhf Treatments To the Clinical Pathwaysupporting

confidence: 91%

Cost-Effectiveness analisys on the implementation of clinical pathway of pediatric treatment for dengue hemorrhagic fever in PKU Muhammadiyah Hospital Yogyakarta

et al. 2020

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Dengue Hemorrhagic Fever (DHF) remains a concerning global problem, especially in Indonesia. This issue particularly deals with the current practice of therapeutic management for pediatric DHF inpatients that does not follow the standard clinical pathway, resulting in increased treatment costs. On this account, a clinical pathway is expected to minimize these costs and reduce patient's length of stay (LoS). However, a cost-effectiveness analysis prior to its implementation in DHF treatments for pediatric patients at PKU Muhammadiyah Hospital, Yogyakarta, is necessary. A retrospective cohort study and cost-effectiveness analysis were carried out from the hospital's (provider) perspective. The research involved two groups based on the adherence of the treatments to the clinical pathway, namely the conformity group and non-conformity group, and collected data on direct medical costs of the pediatric DHF treatment and LoS of both groups from 2016 to 2017. The Incremental Cost-Effectiveness Ratio (ICER) of both groups and the Risk Ratio (RR) were calculated as the outcome. The results confirmed that from the 200 patients involved, 138 of which (69%) received treatments conforming to the clinical pathway, while the therapies given to the remaining 62 patients (31%) deviated from it, with a p-value of 0.000 and RR of 1.58. The average calculated costs for these two groups were IDR 1,144,024 + 556.372 and IDR 1,989,723 + 1,296,899, respectively, while the ICER was IDR 826,917. In conclusion, when implemented on pediatric DHF treatments at PKU Muhammadiyah Hospital, Yogyakarta, clinical pathways can shrink LoS by up to 1.58 times and, consequently, save the cost by IDR 919,238 per one-day reduction off of the average LoS.

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“…In studies of other pediatric diseases such as bronchiolitis, differences in LOS of less than 1 day have been reported as clinically important given their association with decreased costs. 39 Additionally, when comparing those patients that demonstrated the longest lengths of stay (those above the 75 th percentile), there appear to be more clinically meaningful differences among patients from different races, particularly among hospitalizations of patients with CD.…”

Section: Discussionmentioning

confidence: 99%

Minority Pediatric Patients with Inflammatory Bowel Disease Demonstrate an Increased Length of Stay

Barnes¹,

Kochar²,

Long³

et al. 2017

Inflammatory Bowel Diseases

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Background Genetic and other biological factors may lead to differences in disease behavior among children with inflammatory bowel disease from different races, which may be further modified by disparities in care delivery. Using the Kids' Inpatient Database (KID), we aimed to evaluate differences in the management of pediatric patients with IBD by race, focusing on length of stay. Methods We performed a cross-sectional analysis using 2000-2012 data from KID, a nationally representative database. We identified pediatric patients (< 18 years of age) with discharge diagnoses of Crohn's disease (CD) or ulcerative colitis (UC). We used multivariable logistic regression to evaluate the relationship between race and length of stay (LOS), controlling for age, payer status need for surgery, and year of admission. Results We identified 27,295 hospitalizations for children with IBD (62% CD and 38% UC), Compared to white patients with CD, black [adjusted odds ratio (aOR) 1.37, 95% CI:1.22–1.53, p<0.001) and Hispanic patients (aOR 1.37, 95%CI:1.19–1.59, p<0.001) with CD demonstrated increased odds of a LOS greater than the 75th percentile. When compared to white patients with UC, Hispanic patients also demonstrated increased odds of a LOS greater than the 75th percentile (aOR 1.20, 95% CI:1.02–1.42, p=0.015). Conclusions After controlling for age, year of admission, and clinical phenotypes, black and Hispanic patients with CD and Hispanic patients with UC had longer LOS than white patients. These may be due to differences in provider/hospital characteristics, socioeconomic differences, and/or differences in genetics and other biological factors.

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Association of Bronchiolitis Clinical Pathway Adherence With Length of Stay and Costs

Abstract: High adherence to bronchiolitis clinical pathway recommendations across care settings was associated with shorter LOS and lower cost.

Cited by 46 publications

References 24 publications

Discharge Criteria for Bronchiolitis

Discharge Criteria for Bronchiolitis

Cost-Effectiveness analisys on the implementation of clinical pathway of pediatric treatment for dengue hemorrhagic fever in PKU Muhammadiyah Hospital Yogyakarta

Minority Pediatric Patients with Inflammatory Bowel Disease Demonstrate an Increased Length of Stay

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