Use of a Large National Database for Comparative Evaluation of the Effect of a Bronchiolitis/Viral Pneumonia Clinical Care Guideline on Patient Outcome and Resource Utilization

Abstract

Evidence-based care guidelines can successfully influence utilization and clinical outcome.

Management of Bronchiolitis in Community Hospitals in Ontario: a Multicentre Cohort Study

“…Several studies evaluating the implementation of bronchiolitis CPGs for inpatient management at pediatric centres have found a reduction in the use of beta-agonist therapy, chest x-rays, and viral testing. [10][11][12][13] A recent study comparing children's hospitals with bronchiolitis CPGs to hospitals without CPGs found that the presence of a CPG was not associated with less use of unnecessary medication and investigations. 36 Interestingly, when change in bronchiolitis inpatient management was examined across many of these same pediatric hospitals before and after publication of the AAP bronchiolitis CPG, a significant improvement was seen in the use of chest x-rays, systemic corticosteroids, and bronchodilators over time.…”

“…9 Several pediatric centres have demonstrated a reduction in the use of beta-agonist therapy, chest x-rays, and viral testing with implementation of a bronchiolitis clinical practice guideline (CPG). [10][11][12][13] However, most children with bronchiolitis who present to a hospital are treated and discharged from the emergency department (ED). [6][7][8] Many are also managed outside children's hospitals where physicians may be less comfortable with bronchiolitis and less familiar with recent literature regarding bronchiolitis management.…”

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

“…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.…”

“…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.…”

“…This strategy was described in one of the studies as "a prove it or don't use it" approach. 29 We labeled either type of usage of a respiratory score as a forcing function because they were both built-in to the usual workflow. The majority of the studies in this review used the same score, developed and published by Cincinnati Children' s Hospital and Medical Center (CCHMC) and known as the WARM score.…”