Related Experiment Videos
Impact of a bronchiolitis guideline: a multisite demonstration project
Uma R Kotagal1, James M Robbins, Narendra M Kini
1Health Policy and Clinical Effectiveness Program, Children's Hospital Medical Center, Cincinnati, OH 45229-3039, USA. KOTK9J@chmcc.org
Insights
Implementing a clinical practice guideline for bronchiolitis in multiple hospitals reduced bronchodilator use and length of stay. This multisite quality improvement initiative showed promising results for pediatric care.
Area of Science:
- Pediatric pulmonology
- Clinical quality improvement
- Evidence-based medicine
Background:
- Bronchiolitis is a common viral respiratory infection in infants.
- Clinical practice guidelines aim to standardize and improve care for bronchiolitis.
- Multisite implementation of guidelines presents unique challenges and opportunities.
Purpose of the Study:
- To evaluate the impact of a multisite implementation of an evidence-based clinical practice guideline for bronchiolitis.
- To assess changes in clinical practice and resource utilization following guideline adoption.
Main Methods:
- A before-and-after study design was employed across eleven Child Health Accountability Initiative (CHAI) hospitals.
- Data were collected on infants under 12 months with their first episode of bronchiolitis.
- Intervention involved guideline implementation in December 1998, with data analysis from seven hospitals for administrative data and five for chart reviews.
Main Results:
- Length of stay significantly decreased post-implementation.
- While overall bronchodilator use remained stable (84%), albuterol use decreased (80% to 75%, p < 0.03).
- Mean doses of bronchodilators and albuterol significantly reduced (p < 0.0001), with modest decreases in other resource use. Readmission rates were unchanged.
Conclusions:
- Successful extension of an evidence-based guideline to seven hospitals was achieved.
- Significant practice changes in bronchiolitis management were observed within one season.
- The multisite CHAI collaborative demonstrates potential for large-scale quality improvement initiatives in healthcare.
Study Objectives:
The purpose of this study was to determine the impact of a multisite implementation of an evidence-based clinical practice guideline for bronchiolitis.
Design:
Before and after study.
Setting:
Eleven Child Health Accountability Initiative (CHAI) study hospitals.
Patients:
Children < 12 months of age with a first-time episode of bronchiolitis.
Intervention:
The guideline was implemented in December 1998. Complete preimplementation and postimplementation administrative data on hospital admissions, resource utilization, and length of stay were available from seven study hospitals. At five sites, chart reviews were conducted for data on the number and type of bronchodilators used.
Measurements And Results:
Complete administrative data were available for 846 historical control subjects and 792 study patients. Length of stay decreased significantly. While the proportion of eligible patients who received any bronchodilator did not change (84%), the proportion of patients who received albuterol decreased from 80 to 75% after guideline implementation (p < 0.03). For patients who received bronchodilators, the mean (+/- SD) number of doses decreased from 13.6 +/- 14.0 to 7.3 +/- 9.1 doses (p < 0.0001). For patients who received albuterol, the mean number of doses decreased from 12.8 +/- 11.8 to 6.4 +/- 7.8 doses (p < 0.0001). Other resource use decreased modestly. Hospital readmission rates within 7 days of discharge were unchanged.
Conclusions:
We successfully extended the implementation of an evidence-based clinical practice guideline from one hospital to seven hospitals. Within just a single bronchiolitis season, some significant changes in practice were seen. The multisite CHAI collaborative appears to be a promising laboratory for large-scale quality improvement initiatives.