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

Abstract

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

Association of Bronchiolitis Clinical Pathway Adherence With Length of Stay and Costs

“…Studies examining the success of clinical pathway or CPG implementation have generally focused on process measures, including activation of order sets and the use of medical treatments and therapies. 11,12,14,28,30 Our study demonstrates the importance of using more refined measures of adherence to fully understand whether clinical pathways and CPGs are being implemented as intended and that doing so across the ED and inpatient settings can lead to measurable differences in health care use and cost. Because variation in care for bronchiolitis still exists across hospitals nationally, institutions should consider routinely assessing adherence to evidence-based quality indicators.…”

Sustainability in the AAP Bronchiolitis Quality Improvement Project

“…Multiyear bronchiolitis QI projects are limited to single-center studies, and results have been mixed. 5,6,8,[10][11][12][13] One study 11 observed continued improvement in bronchodilator use in subsequent seasons, whereas a second study 10 observed a return to baseline bronchodilator use in the following season. Mittal 6 observed inconsistent improvements in key bronchiolitis measures during postintervention seasons.…”

Benchmarking Overuse of Medical Interventions for Bronchiolitis

“…Potential ABCs for inpatient care in bronchiolitis are proposed in the Table. These ABCs are derived from 3 diverse sources, the Pediatric Health Information System database, 5 …”