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A cluster randomized controlled trial comparing three methods of disseminating practice guidelines for children with
David W Johnson1, William Craig, Rollin Brant
1Department of Pediatrics, Faculty of Medicine, University of Calgary, Calgary Alberta, Canada. david.johnson@calgaryhealthregion.ca
Insights
Implementing practice guidelines for croup management in children can reduce hospitalizations. This study compares three strategies to find the most cost-effective approach for improving care and reducing healthcare system burdens.
Area of Science:
- Pediatric respiratory illnesses
- Healthcare management and economics
Background:
- Croup is a common childhood respiratory illness with established optimal management.
- Corticosteroid treatment for croup reduces intubation, hospitalization, and return visits, offering cost-savings without significant adverse effects.
- A gap exists between established knowledge and clinical practice in croup management.
Purpose of the Study:
- To identify the most cost-effective strategies for implementing croup management guidelines from a societal perspective.
- To compare the costs and benefits of three distinct guideline implementation strategies.
- To determine which strategy best bridges the gap between evidence-based practice and actual clinical care for croup.
Main Methods:
- A matched pair cluster trial involving 24 Alberta hospitals randomized into three intervention groups.
- Mixed methods assessment including administrative database linkage, medical chart audits, and parent telephone surveys.
- Intervention strategies ranged from low (mailing materials) to intermediate (mailing plus interactive education) to high intensity (mailing, interactive education, outreach, reminders, opinion leader engagement, and consensus processes).
Main Results:
- The primary objective is to determine the most effective intervention strategy for reducing hospital days per 1,000 croup episodes.
- Secondary objectives include identifying the most effective strategy for increasing the use of beneficial therapies.
- An economic analysis will assess which strategy most effectively reduces total societal costs, encompassing healthcare and family expenses.
Conclusions:
- The study aims to provide evidence-based recommendations for optimizing croup care implementation.
- Findings will guide healthcare systems in selecting the most efficient and effective methods for disseminating and implementing clinical practice guidelines.
- The research will contribute to reducing healthcare costs and improving patient outcomes for childhood croup.
Background:
The optimal management of croup--a common respiratory illness in young children--is well established. In particular, treatment with corticosteroids has been shown to significantly reduce the rate and duration of intubation, hospitalization, and return to care for on-going croup symptoms. Furthermore treatment with a single dose of corticosteroids does not appear to result in any significant adverse outcomes, and yields overall cost-savings for both families and the health care system. However, as has been shown with many other diseases, there is a significant gap between what we know and what we do. The overall aim of this study is to identify, from a societal perspective, the costs and associated benefits of three strategies for implementing a practice guideline that addresses the management of croup.
Methods/Designs:
We propose to use a matched pair cluster trial in 24 Alberta hospitals randomized into three intervention groups. We will use mixed methods to assess outcomes including linkage and analysis of administrative databases obtained from Alberta Health and Wellness, retrospective medical chart audit, and prospective telephone surveys of the parents of children diagnosed to have croup. The intervention strategies to be compared will be mailing of printed educational materials (low intensity intervention), mailing plus a combination of interactive educational meetings, educational outreach visits, and reminders (intermediate intensity intervention), and a combination of mailing, interactive sessions, outreach visits, reminders plus identification of local opinion leaders and establishment of local consensus processes (high intensity intervention). The primary objective is to determine which of the three intervention strategies are most effective at lowering the rate of hospital days per 1,000 disease episodes. Secondary objectives are to determine which of the three dissemination strategies are most effective at increasing the use of therapies of known benefit. An economic analysis will be conducted to determine which of the three intervention strategies will most effectively reduce total societal costs including all health care costs, costs borne by the family, and costs stemming from the strategies for disseminating guidelines.
