Inpatient Bronchiolitis Guideline Implementation and Resource Utilization

Mittal, Vineeta; Darnell, Cindy; Walsh, Brian K; Mehta, Amit; Badawy, Mohamed; Morse, Rustin B.; Pop, Rodica; Tidwell, Jerithea; Sheehan, Maeve; McDermott, S J; Cannon, Carolyn L.; Kahn, Jason D.

doi:10.1542/peds.2013-2881

Cited by 94 publications

(96 citation statements)

References 25 publications

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“…Mittal et al recently published their experience with a similar project implementing a guideline intended to reduce resource utilization in bronchiolitis, 25 providing a useful comparison by which to benchmark our project. We achieved a 29% reduction in bronchodilator use (to 32.7%), whereas Mittal reported a 48% reduction by the second year of the project (to 14%).…”

Section: Discussionmentioning

confidence: 99%

“…10,11 Furthermore, many institutions have published their own experience in reducing unnecessary care by using local guidelines and other quality improvement (QI) methods. [12][13][14][15][16][17][18][19][20][21][22][23][24][25] Most published QI work has been accomplished in academic children's hospitals, whereas the large majority of children's care is delivered in community settings. Of the estimated 1.8 million, non-birth-associated childhood hospitalizations in the United States in 2012, only 28% occurred in freestanding children's hospitals according to the 2012 Kid's Inpatient Database.…”

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confidence: 99%

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A Multicenter Collaborative to Reduce Unnecessary Care in Inpatient Bronchiolitis

et al. 2016

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Dr Ralston conceptualized the project and codirected its implementation, coordinated and critically reviewed all analyses, and drafted the initial manuscript; Dr Garber conceptualized the project and codirected its implementation and critically reviewed and revised the manuscript; Ms Rice-Conboy coordinated all aspects of project design, implementation, and data collection and critically reviewed and revised the manuscript; Drs Mussman, Shadman, and Walley provided project leadership and content, performed a portion of the analysis, and critically reviewed and revised the manuscript; Ms Nichols performed the analyses, prepared all tables and fi gures, and critically reviewed the manuscript; and all authors approved the fi nal manuscript as submitted.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

A Multicenter Collaborative to Reduce Unnecessary Care in Inpatient Bronchiolitis

et al. 2016

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“…Previously reported utilization has ranged from 45% to 50%, again demonstrating that the achievable benchmark is a goal to lower utilization. 3,25 Pneumonia Although routine testing for uncomplicated pneumonia is discouraged, there was large variation of use among the hospitals. Erythrocyte sedimentation rate use was infrequent, but it is noteworthy thatitsusewasmorecommoninthelower Hospital performance according to diagnosis and clinical quality indicator.…”

Section: Bronchiolitismentioning

confidence: 99%

Establishing Benchmarks for the Hospitalized Care of Children With Asthma, Bronchiolitis, and Pneumonia

et al. 2014

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WHAT'S KNOWN ON THIS SUBJECT: With the publication of evidence-based guidelines for asthma, bronchiolitis, and pneumonia, numerous efforts have been made to standardize and improve the quality of care. However, despite these guidelines, variation in care exists. WHAT THIS STUDY ADDS:This study establishes clinically achievable benchmarks of care for asthma, bronchiolitis, and pneumonia. Using a published method for achievable benchmarks of care, we calculated average utilization among the high-performers, which can serve as achievable goals for local quality improvement. abstract BACKGROUND AND OBJECTIVES: Asthma, pneumonia, and bronchiolitis are the leading causes of admission for pediatric patients; however, the lack of accepted benchmarks is a barrier to quality improvement efforts. Using data from children hospitalized with asthma, bronchiolitis, or pneumonia, the goals of this study were to: (1) measure the 2012 performance of freestanding children' s hospitals using clinical quality indicators; and (2) construct achievable benchmarks of care (ABCs) for the clinical quality indicators. METHODS:This study was a cross-sectional trial using the Pediatric Health Information System database. Patient inclusions varied according to diagnosis: asthma (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] codes 493.0-493.92) from 2 to 18 years of age; bronchiolitis ) from 2 months to 2 years of age; and pneumonia (ICD-9-CM codes 480-486, 487.0) from 2 months to 18 years of age. ABC methods use the best-performing hospitals that comprise at least 10% of the total population to compute the benchmark. RESULTS:Encounters from 42 hospitals included: asthma, 22 186; bronchiolitis, 14 882; and pneumonia, 12 983. Asthma ABCs include: chest radiograph utilization, 24.5%; antibiotic administration, 6.6%; and ipratropium bromide use .2 days, 0%. Bronchiolitis ABCs include: chest radiograph utilization, 32.4%; viral testing, 0.6%; antibiotic administration, 18.5%; bronchodilator use .2 days, 11.4%; and steroid use, 6.4%. Pneumonia ABCs include: complete blood cell count utilization, 28.8%; viral testing, 1.5%; initial narrow-spectrum antibiotic use, 60.7%; erythrocyte sedimentation rate, 3.5%; and C-reactive protein, 0.1%. CONCLUSIONS:We report achievable benchmarks for inpatient care for asthma, bronchiolitis, and pneumonia. The establishment of national benchmarks will drive improvement at individual hospitals. Clinical practice guidelines (CPGs) are systematically developed statements that can guide providers in decisionmaking. 1 CPGs are intended to reduce variation, which in turn is expected to lower costs and improve outcomes. Despite the availability of national CPGs for 3 of the most common pediatric inpatient conditions (asthma, bronchiolitis, and pneumonia), wide variation in their management continues across US hospitals, leading to excess resource utilization and cost of care. 2-7 Improvements have been modest at best; 1 possible reason is that although the guidelines make recomm...

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“…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%

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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Inpatient Bronchiolitis Guideline Implementation and Resource Utilization

Cited by 94 publications

References 25 publications

A Multicenter Collaborative to Reduce Unnecessary Care in Inpatient Bronchiolitis

A Multicenter Collaborative to Reduce Unnecessary Care in Inpatient Bronchiolitis

Establishing Benchmarks for the Hospitalized Care of Children With Asthma, Bronchiolitis, and Pneumonia

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

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