Hospitalist and Nonhospitalist Adherence to Evidence-Based Quality Metrics for Bronchiolitis

McCulloh, Russell J.; Smitherman, Sarah; Adelsky, Solomon; Congdon, Morgan; Librizzi, Jamie; Koehn, Kristin; Alverson, Brian

doi:10.1542/hpeds.2011-0002-2

Cited by 15 publications

(12 citation statements)

References 30 publications

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“…Both sites have full‐time pediatric hospitalist services as well as specialist and community pediatricians that admit children for general inpatient pediatric illnesses. As has been reported elsewhere, 34% of patients at site 1 and 74% of patients at site 2 were cared for by pediatric hospitalists. During study periods, bronchiolitis diagnosis and management was based on individual physician practice at both study sites; no formalized care pathways were utilized and illness severity was based primarily on clinical impression without widespread use of a standardized scoring system.…”

Section: Methodssupporting

confidence: 74%

“…Additionally, there is a strong call for objective and measurable quality measures in pediatrics, but not all quality measures are adopted after careful study. Guidelines created using evidence‐based medicine are a logical starting point for selecting quality measures, and quality measures based on the 2006 bronchiolitis guideline have been proposed . Determining the impact of guidelines on physician behavior is critical for measuring efficacy of the guideline and may be helpful in assessing overall quality of care.…”

Section: Introductionmentioning

confidence: 99%

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Assessing the impact of national guidelines on the management of children hospitalized for acute bronchiolitis

et al. 2013

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Section: Methodssupporting

confidence: 74%

Section: Introductionmentioning

confidence: 99%

Assessing the impact of national guidelines on the management of children hospitalized for acute bronchiolitis

et al. 2013

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“…The most common form of variation was unwarranted variation in effective care including overuse of care that is not evidence based (e.g. antibiotics in bronchiolitis) and underuse of care that has been shown to be effective (e.g. oral sucrose to alleviate pain in infants).…”

Section: Executive Summarymentioning

confidence: 99%

Variation in paediatric clinical practice: A review of care in inpatient, outpatient and emergency department settings

Perera

McLean

Roberts

et al. 2016

J Paediatrics Child Health

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Hospital Boston, noted the following: 'If all variation were bad then solutions would be easy. The difficulty is in reducing bad variation, which reflects the limits of professional knowledge, and failures in its application, whilst preserving the good variation that makes care patient centred.' 1 Variation in care refers to variation in diagnostic and treatment practices, including medications prescribed, imaging and pathology ordered, procedures and interventions performed, and referrals made. It is important because it inevitably reflects variation in quality of care and associated costs. Whilst the British Medical Journal editorial statement is undoubtedly true, there is little published about variation in paediatric clinical practice. Before paediatricians and policy makers can begin to sort 'good' or warranted from 'bad' or unwarranted variation, we need a deeper understanding within paediatric practice of where variation occurs, what aspects are considered to be warranted or unwarranted and whether there are modifiable, systems-based factors that can reduce the latter. To this end, the then NSW Kids and Families commissioned a rapid review of the evidence of variation in paediatric clinical care in inpatient, outpatient and emergency department (ED) settings. The full review was published in November 2014 and is available at https://www.saxinstitute.org.au/publications/evidencecheck-library/variation-in-paediatric-clinical-practice/.2 A rapid review is a form of knowledge synthesis in which components of the systematic review process are simplified or omitted to produce information in a timely manner (e.g. omission of study quality ratings, as per this review). 3 The review focused on variation in care in developed countries for 16 common child health conditions and systemic factors associated with this variation. The following databases were searched: Ovid MEDLINE, CINAHL (EBSCO), PsychInfo, Cochrane library and PubMed, as well as published reviews, and references of retrieved, relevant articles. This paper presents an executive summary of the review along with research and policy implications arising. Executive SummaryVariation in paediatric clinical care is common. It occurs across diseases, clinicians and settings. Wennberg's framework is the most common framework used to understand variation in clinical care. 4It describes both warranted and unwarranted variation, with unwarranted variation being defined as 'variation that cannot be explained by type or severity of illness or by patient preferences'. Unwarranted variation is further categorised as variation in the following:• effective care, that is, when proven, clinically effective care is not used; • preference-sensitive care, that is, where there are two or more choices for care and the choice made is ideally be driven by patient preferences; and • supply-sensitive care, that is, when variation arises not due to evidence but due to supply of health-care resources such as doctors or diagnostic services. The review found widespread variation across...

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“…However, some clinicians believe the AAP guideline does not reflect routine practice, and implementation of the guideline remains highly variable (Christakis et al, 2005;Johnson et al, 2013;McCulloh et al, 2012). Provider treatment preference, rather than evidence-based practice, continues to be common (Mittal, et al, 2014;Sangrador, Gonzalos de Dios, & Research Group of the aBREVIADo Project, 2013).…”

mentioning

confidence: 99%

“…The author of one study found that hospitalists discontinued unnecessary systemic corticosteroid therapy and antibiotic therapy more frequently than did nonhospitalists (McCulloh, 2012). A study of patients with bronchiolitis in the ED found that although use of chest radiographs significantly decreased after publication of the AAP guidelines, there has not been a decrease in use of nonrecommended therapies such as antibiotics, bronchodilators, and systemic corticosteroids (Johnson et al, 2013).…”

mentioning

confidence: 99%

Implementing a Clinical Practice Guideline for the Treatment of Bronchiolitis in a High-Risk Hispanic Pediatric Population

Zamora-Flores¹,

Busen²,

Smout³

et al. 2015

Journal of Pediatric Health Care

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Hospitalist and Nonhospitalist Adherence to Evidence-Based Quality Metrics for Bronchiolitis

Cited by 15 publications

References 30 publications

Assessing the impact of national guidelines on the management of children hospitalized for acute bronchiolitis

Assessing the impact of national guidelines on the management of children hospitalized for acute bronchiolitis

Variation in paediatric clinical practice: A review of care in inpatient, outpatient and emergency department settings

Implementing a Clinical Practice Guideline for the Treatment of Bronchiolitis in a High-Risk Hispanic Pediatric Population

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