Impact of an Educational Intervention to Improve Physician Adherence to Bronchiolitis Clinical Practice Guidelines: A Pre-Post Intervention Study

Genies, Marquita; Kim, Julia Minjung; Pyclik, Kristina; Rossi, Suzanne; Spicyn, Natalie; Serwint, Janet R.

doi:10.1177/0009922817698804

Cited by 14 publications

(13 citation statements)

References 14 publications

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“…Rates of bronchodilator use showed a nonsignificant decrease from 22.2% to 17.8%, with both pre- and post-intervention rates lower than rates achieved after an inpatient-only intervention at our institution during the 2014-2015 bronchiolitis season. 9 Our post-intervention inpatient bronchodilator use rate was again similar to the rates achieved in the multisite collaborative to Mussman et al (17.7%). 14 Importantly, the decrease in unnecessary interventions for patients with a diagnosis of bronchiolitis, particularly in the emergency department setting, did not lead to an increase in length in stay or need for escalation of care to the PICU.…”

Section: Discussionsupporting

confidence: 88%

“…A prior institutional educational intervention in the inpatient setting reduced the use of non–evidence-based therapies, leading to a 50% reduction in bronchodilator utilization. Most (82%) of the patients who received bronchodilators in this study had first received them in the emergency department prior to admission, 9 indicating the need for a hospital-wide educational intervention that included both the emergency and inpatient settings. Larger collaboratives have shown similar improvements in the inpatient setting and note the need to extend interventions across settings.…”

Section: Introductionmentioning

confidence: 94%

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Targeted Education Across Clinical Settings Improves Adherence to Evidence-Based Interventions for Bronchiolitis

Molloy

Tamaroff

McDaniel

et al. 2019

Clin Pediatr (Phila)

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Bronchiolitis remains a leading cause of hospitalization of infants. Despite evidence-based recommendations, wide variation in practice remains. A pre-post educational intervention was implemented to improve adherence to bronchiolitis guidelines in emergency and inpatient settings. Among children meeting inclusion criteria (136 pre-intervention, 185 post-intervention), emergency department (ED) bronchodilator use decreased by 64% ( P < .001). Steroid use decreased by 71% ( P = .002). There was no difference in viral testing, antibiotic use, or chest radiograph acquisition. No differences were seen in the inpatient setting. There was no difference in rate of intensive care unit transfer or length of stay. Post-intervention, children were less likely to receive a bronchodilator in the ED (odds ratio [OR] = 0.15, P < .001). Children with a family history of asthma were more likely to receive a bronchodilator in the ED (OR = 4.25, P < .001). Targeted education across settings contributed to reducing bronchodilator use in the ED. Family history appeared to influence medical decision making.

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Section: Discussionsupporting

confidence: 88%

Section: Introductionmentioning

confidence: 94%

Targeted Education Across Clinical Settings Improves Adherence to Evidence-Based Interventions for Bronchiolitis

Molloy

Tamaroff

McDaniel

et al. 2019

Clin Pediatr (Phila)

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“…A 2014 systematic review 18 of 14 published QI initiatives in inpatient bronchiolitis care found that these interventions were associated with reductions in bronchodilator, steroid, antibiotic, and CR use. The QI efforts included in this review or published after the review have been associated with reduced use of nonrecommended services by implementing local clinical pathways citing AAP recommendations [19][20][21][22][23][24][25][26][27][28][29] ; international studies using other national guidelines as the basis for local improvements have been associated with similar improvements. [30][31][32][33] Such QI efforts constitute 1…”

Section: Jama Network Open | Pediatricsmentioning

confidence: 99%

Trends Over Time in Use of Nonrecommended Tests and Treatments Since Publication of the American Academy of Pediatrics Bronchiolitis Guideline

et al. 2021

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IMPORTANCE Acute viral bronchiolitis is a common and costly pediatric condition for which clinical practice guidelines discourage use of diagnostic tests and therapies. OBJECTIVE To evaluate trends over time for use of nonrecommended services for bronchiolitis since publication of the American Academy of Pediatrics clinical practice guideline on bronchiolitis (originally published in October 2006 and updated in November 2014). DESIGN, SETTING, AND PARTICIPANTS This cohort study was conducted using interrupted timeseries regression analysis adjusting for the hospital providing service, patient demographic characteristics, and payer, with 2014 guideline update publication as the event point. Included patients were children younger than 2 years old discharged from the emergency department (ED) or hospital inpatient setting with a primary diagnosis of bronchiolitis at US Children's Hospitals contributing data to the Pediatric Health Information Systems database. Data were analyzed from June through December 2020. MAIN OUTCOMES AND MEASURES Rates of nonrecommended tests (ie, chest radiography, viral testing, and complete blood cell count) and treatments (ie, bronchodilators, corticosteroids, antibiotics) were measured. RESULTS Among 602 375 encounters involving children with a primary diagnosis of bronchiolitis, 404 203 encounters (67.1%) were ED discharges and 198 172 encounters (32.9%) were inpatient discharges; 468 226 encounters (77.7%) involved children younger than 12 months, and 356 796 encounters (59.2%) involved boys. In the period after initial guideline publication (ie, November 2006 to November 2014), a negative use trajectory was found in all measures except viral testing in the ED group. Using the 2014 guideline update as the event point, several measures showed decreased use between study time periods. The greatest decrease was in bronchodilator use, which changed by −13.5 percentage points in the ED group (95% CI, −15.2 percentage points to −11.8 percentage points) and −11.3 percentage points in the inpatient group (95% CI, −13.1 percentage points to −9.4 percentage points). In the period after the 2014 guideline update (ie, December 2014 to December 2019), bronchodilators also showed the greatest change in usage trajectory, steepening more than 2-fold in both groups. In the ED group, the negative trajectory steepened from −0.11% monthly (95% CI, −0.13% to −0.09%) in the first guideline period to a new mean monthly slope of −0.26% (95% CI, −0.30% to −0.23%). In the inpatient group, the mean monthly slope steepened from −0.08% (95% CI, −0.10 to −0.05%) to −0.26% (95% CI, 0.30% to −0.22%). Length of stay decreased from 2.0 days (95% CI, 1.9 days to 2.1 days) to 1.7 days (95% CI, 1.7 days to 1.8 days). Hospital admission rate decreased from 18.0% (95% CI, 13.8% to 22.2%) to 17.8% (95% CI, 13.6 to 22.1%).

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“…There may also have been differences in guideline uptake, lack of individual hospitalist feedback, or difficulty in changing culture. 6,[42][43][44][45] Future studies should examine reasons for bronchiolitis guideline nonadherence.…”

Section: Discussionmentioning

confidence: 99%

Timely Data for Targeted Quality Improvement Interventions: Use of a Visual Analytics Dashboard for Bronchiolitis

et al. 2019

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Background Standard methods for obtaining data may delay quality improvement (QI) interventions including for bronchiolitis, a common cause of childhood hospitalization. Objective To describe the use of a dashboard in the context of a multifaceted QI intervention aimed at reducing the use of chest radiographs, bronchodilators, antibiotics, steroids, and viral testing in patients with bronchiolitis. Methods This QI initiative took place at Children's Minnesota, a large, not-for-profit children's health care organization. A multidisciplinary bronchiolitis workgroup developed a local clinical guideline and order-set. Delays in obtaining baseline data prompted a pediatric hospitalist and information technology specialist to modify a vendor's dashboard to display data related to bronchiolitis guideline metrics. Patients 2 months to 2 years old with a bronchiolitis emergency department (ED)/inpatient encounter in the period October 1, 2014 to April 30, 2018 were included. The primary outcome was a functioning dashboard; a process measure was the percentage of ED clinician logins. Outcome measures included the percent use of guideline metrics (e.g., bronchodilators) displayed on statistical process control charts (ED vs. inpatient). Balancing measures included length of stay, charge ratios, and hospital revisits. Results A workgroup (formed October 2015) implemented a bronchiolitis order-set and guideline (February 2016) followed by a bronchiolitis dashboard (August 2016) consolidating disparate data sources loaded within 2 to 4 days of discharge. In total, 35% of ED clinicians logged in. Leaders used the dashboard to target and track interventions such as a bronchodilator order alert. There were improvements in most outcome metrics; however, timing did not suggest direct dashboard impact. ED balancing measures were lower after implementation. Conclusion We described use of a dashboard to support a multifaceted QI initiative for bronchiolitis. Leaders used the dashboard for targeted interventions but the dashboard did not directly impact the observed improvements. Future studies should assess reasons for low individual dashboard use.

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Impact of an Educational Intervention to Improve Physician Adherence to Bronchiolitis Clinical Practice Guidelines: A Pre-Post Intervention Study

Cited by 14 publications

References 14 publications

Targeted Education Across Clinical Settings Improves Adherence to Evidence-Based Interventions for Bronchiolitis

Targeted Education Across Clinical Settings Improves Adherence to Evidence-Based Interventions for Bronchiolitis

Trends Over Time in Use of Nonrecommended Tests and Treatments Since Publication of the American Academy of Pediatrics Bronchiolitis Guideline

Timely Data for Targeted Quality Improvement Interventions: Use of a Visual Analytics Dashboard for Bronchiolitis

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