Sustaining the Implementation of an Evidence-Based Guideline for Bronchiolitis

Perlstein, Paul H; Kotagal, Uma R.; Schoettker, Pamela J.; Atherton, Harry D.; Farrell, Michael; Gerhardt, W; Alfaro, Mary Pat

doi:10.1001/archpedi.154.10.1001

Cited by 74 publications

(56 citation statements)

References 33 publications

(37 reference statements)

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“…However, most of these studies were in the inpatient setting, with the extent of reduction in CXRs, viral testing, and bronchodilator use widely varying between studies. 17,[25][26][27][28][29][30] Furthermore, studies on the cost impact of bronchiolitis guidelines have been mixed and mostly in the inpatient setting. 25,26,29 To our knowledge, no previous study has quantified the cost impact of a bronchiolitis guideline in an ED.…”

Section: Discussionmentioning

confidence: 99%

Impact of a Bronchiolitis Guideline on ED Resource Use and Cost: A Segmented Time-Series Analysis

et al. 2014

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OBJECTIVE: Bronchiolitis is a major cause of infant morbidity and contributes to millions of dollars in health care costs. Care guidelines may cut costs by reducing unnecessary resource utilization. Through the implementation of a guideline, we sought to reduce unnecessary resource utilization and improve the value of care provided to infants with bronchiolitis in a pediatric emergency department (ED). METHODS:We conducted an interrupted time series that examined ED visits of 2929 patients with bronchiolitis, aged 1 to 12 months old, seen between November 2007 and April 2013. Outcomes were proportion having a chest radiograph (CXR), respiratory syncytial virus (RSV) testing, albuterol or antibiotic administration, and the total cost of care. Balancing measures included admission rate, returns to the ED resulting in admission within 72 hours of discharge, and ED length of stay (LOS).RESULTS: There were no significant preexisting trends in the outcomes. After guideline implementation, there was an absolute reduction of 23% in CXR (95% confidence interval [CI]: 11% to 34%), 11% in RSV testing (95% CI: 6% to 17%), 7% in albuterol use (95% CI: 0.2% to 13%), and 41 minutes in ED LOS (95% CI: 16 to 65 minutes). Mean cost per patient was reduced by $197 (95% CI: $136 to $259). Total cost savings was $196 409 (95% CI: $135 592 to $258 223) over the 2 bronchiolitis seasons after guideline implementation. There were no significant differences in antibiotic use, admission rates, or returns resulting in admission within 72 hours of discharge.CONCLUSIONS: A bronchiolitis guideline was associated with reductions in CXR, RSV testing, albuterol use, ED LOS, and total costs in a pediatric ED. Pediatrics 2014;133:e227-e234 AUTHORS:

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Section: Discussionmentioning

confidence: 99%

Impact of a Bronchiolitis Guideline on ED Resource Use and Cost: A Segmented Time-Series Analysis

et al. 2014

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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%

“…Simpson et al 32 presented data included in a larger study (Kotagal et al 31 ) and is described but was excluded from the data analysis. Data presented in the 1999 study by Perlstein et al 26 was also included in the 2000 study by Perlstein et al 27 and are analyzed in our report primarily from the 2000 article, except for one measure (doses per patient of bronchodilator), which is only reported in the 1999 article. Muething et al 33 …”

Section: Duplicate Datamentioning

confidence: 99%

“…No individual study reported a negative impact on readmission rates, and 2 studies reported a statistically significant positive impact of the intervention. 27,34 Costs were analyzed in 4 studies, all using differing methods. Four studies reported decreased charges or costs associated with the intervention, 26,27,30,36 and 1 study reported no change.…”

Section: Harms/balancing Measuresmentioning

confidence: 99%

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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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“…With proper implementation, clinical practice guidelines for bronchiolitis can reduce healthcare resource usage by up to 77% without negatively impacting clinical outcomes or patient family's satisfaction [23,[25][26][27][28]. However, due to an insufficient level of detail and limited amounts of evidence, existing clinical practice guidelines provide guidance for a limited number of patients and still rely heavily on individualized clinician judgment.…”

Section: Introductionmentioning

confidence: 99%

A systematic review of predictive modeling for bronchiolitis

Luo

Nkoy

Gesteland

et al. 2014

International Journal of Medical Informatics

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Purpose: Bronchiolitis is the most common cause of illness leading to hospitalization in young children. At present, many bronchiolitis management decisions are made subjectively, leading to significant practice variation among hospitals and physicians caring for children with bronchiolitis. To standardize care for bronchiolitis, researchers have proposed various models to predict the disease course to help determine a proper management plan. This paper reviews the existing state of the art of predictive modeling for bronchiolitis. Predictive modeling for respiratory syncytial virus (RSV) infection is covered whenever appropriate, as RSV accounts for about 70% of bronchiolitis cases.Methods: A systematic review was conducted through a PubMed search up to April 25, 2014. The literature on predictive modeling for bronchiolitis was retrieved using a comprehensive search query, which was developed through an iterative process.Search results were limited to human subjects, the English language, and children (birth-18 years). Results:The literature search returned 2,312 references in total. After manual review, 168 of these references were determined to be relevant and are discussed in this paper. We identify several limitations and open problems in predictive modeling for bronchiolitis, and provide some preliminary thoughts on how to address them, with the hope to stimulate future research in this domain. Conclusions:Many problems remain open in predictive modeling for bronchiolitis. Future studies will need to address them to achieve optimal predictive models.

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Sustaining the Implementation of an Evidence-Based Guideline for Bronchiolitis

Abstract: To describe the changes occurring over a 3-year period after implementation of an evidencebased clinical practice guideline for the care of infants with bronchiolitis.

Cited by 74 publications

References 33 publications

Impact of a Bronchiolitis Guideline on ED Resource Use and Cost: A Segmented Time-Series Analysis

Impact of a Bronchiolitis Guideline on ED Resource Use and Cost: A Segmented Time-Series Analysis

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

A systematic review of predictive modeling for bronchiolitis

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