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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
Chest
|June 18, 2002
Summary
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.