Assessing the quality of health care in the management of bronchiolitis in Australian children: a population-based sample survey

Abstract

BackgroundBronchiolitis is the most common cause of respiratory hospitalisation in children aged <2 years. Clinical practice guidelines (CPGs) suggest only supportive management of bronchiolitis. However, the availability of CPGs do not guarantee that they are used appropriately and marked variation in the clinical management exists. We conducted an assessment of guideline adherence in the management of bronchiolitis in children at a subnationally representative level including inpatient and ambulatory services in Australia.MethodsWe searched for national and international CPGs relating to management of bronchiolitis in children and identified 16 recommendations which were formatted into 40 medical record audit indicator questions. A retrospective medical record review assessing compliance with the CPGs was conducted across three types of healthcare setting: hospital inpatient admissions, emergency department (ED) presentations and general practice (GP) consultations in three Australian states for children aged <2 years receiving care in 2012 and 2013.ResultsPurpose-trained surveyors conducted 13 979 eligible indicator assessments across 796 visits for bronchiolitis at 119 sites. Guideline adherence for management of bronchiolitis was 77.3% (95% CI 72.6 to 81.5) for children attending EDs, 81.6% (95% CI 78.0 to 84.9) for inpatients and 52.3% (95% CI 44.8 to 59.7) for children attending GP consultations. While adherence to some individual indicators was high, overall adherence to documentation of 10 indicators relating to history taking and examination was poorest and estimated at 2.7% (95% CI 1.5 to 4.4).ConclusionsThe study is the first to assess guideline-adherence in both hospital (ED and inpatient) and GP settings. Our study demonstrated that while the quality of care for bronchiolitis was generally adherent to CPG indicators, specific aspects of management were deficient, especially documentation of history taking.

Evaluating the Effect of Vitamin A on Persistent Wheezing in Infants with Bronchiolitis in Southern Iran in 2018

“…In a study in Australia on 206 children aged 2-7 years with a history of bronchiolitis leading to hospitalization, measuring serum levels of vitamin A and its administration showed that administration of vitamin A supplements could not raise serum retinol levels, and it did not affect the morbidity rate (30). These results are in contrast with the results of our study.…”

Process over outcome quality in paediatrics? An analysis of outpatient healthcare quality indicators for seven common diseases

“…For example, Ewald et al 14 developed a set of 42 QIs to assess the quality of paediatric primary care in Europe as part of the COSI PPC-EU study (Core set of quality indicators for Paediatric primary care practices in Europe). Another example is the Care Track Kids study, for which Homaira et al 15 designed a QI set for 17 common diseases, such as bronchiolitis, to assess the quality of paediatric primary care in Australia. To date, two reviews have compiled and examined QIs for assessing healthcare of children and adolescents.…”

Clinical Epidemiological Characteristics and Risk Factors for Severe Bronchiolitis Caused by Respiratory Syncytial Virus in Vietnamese Children

“…Bronchiolitis is the most prevalent cause of hospitalization in infants under the age of 12 months, resulting in a significant increase in expenditure to healthcare systems and families [1,2]. Acute bronchiolitis is the inflammation of the bronchioles, which is most typically caused by a virus and is common in children under the age of two [3][4][5]. The disease is distinguished by its regularity of incidence, which is highest during the winter months of November to March [6].…”