Benchmarking Overuse of Medical Interventions for Bronchiolitis

Ralston, Shawn L.; Parikh, Kavita; Goodman, David C.

doi:10.1001/jamapediatrics.2015.1372

Cited by 21 publications

(15 citation statements)

References 8 publications

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“…Our QI intervention combining guideline education, peer comparisons, and accountable justification resulted in reductions in albuterol and CR use with no change in corticosteroid use. Although the "right rate" of albuterol use in bronchiolitis is not known, our postintervention rates are similar to the achievable benchmarks of care for bronchiolitis proposed by Ralston et al 26 for ED and inpatient care, while our CR and steroid use was lower. When controlling for previous trends via ITS, only albuterol use declined significantly.…”

Section: Discussionsupporting

confidence: 83%

Use of Social Psychology to Improve Adherence to National Bronchiolitis Guidelines

et al. 2019

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OBJECTIVES:The American Academy of Pediatrics' bronchiolitis guidelines recommend against albuterol and corticosteroids for treating and chest radiographs (CRs) for diagnosing infants with bronchiolitis. However, high rates of nonadherence have been documented. Our objective was to improve guideline adherence in infants with bronchiolitis.METHODS: This quality improvement study was conducted in 1 urban academic pediatric primary care clinic caring for predominately minority and publicly insured children. We tested provider guideline education, display of guidelines in patient care areas, and monthly e-mails to all providers documenting deviation rates, with individual e-mails to providers who deviated. P-charts and interrupted time series analysis were used to estimate the effect of the intervention.RESULTS: There were 380 children <2 years of age with a diagnosis of bronchiolitis in the 16 nonsummer months preintervention and 417 in the 15 postintervention months. Rates of prescribed and administered albuterol declined from 45.7% in the baseline period to 13.7% in the intervention period and CR use dropped from a mean of 10.1% to 3.4%, both demonstrating special cause variation. Steroid use did not change significantly. In interrupted time series analyses, the intervention was associated with a significant decrease in albuterol use (P < .001) but not in CR or steroid use. Emergency department visits declined slightly but admissions for bronchiolitis were stable.CONCLUSIONS: Traditional quality improvement efforts coupled with social psychology techniques resulted in improved guideline adherence in outpatient bronchiolitis management. Additional study will help identify which techniques are most effective for increasing guideline adherence in cases of low-value care.

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Section: Discussionsupporting

confidence: 83%

Use of Social Psychology to Improve Adherence to National Bronchiolitis Guidelines

et al. 2019

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“…Approximately two-thirds of site teams in this collaborative selfdescribed as university-affiliated, compared with approximately half in the B-QIP. Although it has been hypothesized and sometimes demonstrated 25 that sites with an academic affiliation may outperform national averages, performance benchmarks in the B-QIP in fact compared favorably with data that included only academic children's hospitals 26,27 ; and in our collaborative, site teams without an academic affiliation made up a percentage of the top quartile of performers that was similar to the percentage found in the overall collaborative.…”

Section: Discussionmentioning

confidence: 51%

Multisite Emergency Department Inpatient Collaborative to Reduce Unnecessary Bronchiolitis Care

et al. 2018

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“…1 Overuse of ineffective therapies has persisted despite the existence of the evidence-based American Academy of Pediatrics (AAP) clinical practice guideline (CPG), which recommends primarily supportive care. [2][3][4][5][6][7][8] Adherence to the AAP CPG recommendations for management of bronchiolitis improved significantly through the AAP's Bronchiolitis Quality Improvement Project (BQIP), a 12-month, multiinstitutional collaborative of community and free-standing children's hospitals. 9 This subsequent study investigates if these improvements were sustained after completion of the formal 12-month project.…”

Section: Resultsmentioning

confidence: 99%