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Bronchiolitis management before and after the AAP guidelines
Kavita Parikh1, Matthew Hall, Stephen J Teach
1Division of Hospitalist Medicine, 111 Michigan Ave NW, Washington, DC 20010. kparikh@childrensnational.org.
Insights
The 2006 American Academy of Pediatrics bronchiolitis guidelines reduced diagnostic and treatment resource use in hospitalized children. This study analyzed national data, showing significant improvements in care after guideline implementation.
Area of Science:
- Pediatric Medicine
- Evidence-Based Practice
- Healthcare Management
Background:
- The American Academy of Pediatrics (AAP) published evidence-based guidelines in 2006 for bronchiolitis management.
- These guidelines emphasize supportive care and limited diagnostic testing and treatment.
Purpose of the Study:
- To evaluate the impact of the 2006 AAP bronchiolitis guidelines on the treatment of hospitalized children.
- To assess changes in the utilization of diagnostic and therapeutic resources post-guideline publication.
Main Methods:
- Analysis of inpatient data for bronchiolitis patients aged 1-24 months from the Pediatric Health Information System (2004-2012).
- Utilized segmented time series analysis to compare resource utilization before and after the 2006 guidelines.
- Included data from 41 pediatric hospitals, encompassing 130,262 patients.
Main Results:
- Significant improvements observed in the utilization rates of diagnostic tests and medications post-guidelines.
- Segmented regression analysis indicated significant reductions in chest radiography, steroid, and bronchodilator use (P < .0001).
- No significant decrease in antibiotic utilization was noted.
Conclusions:
- The 2006 AAP bronchiolitis guidelines were associated with substantial reductions in diagnostic and therapeutic resource utilization.
- These findings suggest successful implementation of evidence-based practice in a national cohort of pediatric hospitals.
- The study highlights the positive impact of guideline dissemination on clinical practice for bronchiolitis.
Background And Objectives:
Evidence-based practice guidelines for bronchiolitis management published by the American Academy of Pediatrics in 2006 recommend supportive care with limited diagnostic testing and treatment. We sought to determine the impact of these guidelines on the treatment of hospitalized children.
Methods:
We analyzed data on inpatients with bronchiolitis aged 1 to 24 months from the Pediatric Health Information System, an administrative billing database, from November 1, 2004 to March 31, 2012. We compared trends in use of diagnostic and treatment resources before and after the publication of the guidelines by using segmented time series.
Results:
A total of 41 pediatric hospitals contributed data to yield 130,262 patients; 58% were male, and 59% were publicly insured. Median age was 4.0 months (interquartile range, 2-9). Unadjusted analysis showed improvement in utilization rates before and after guidelines for diagnostic tests and for medications; however, there was no decreased use of antibiotics. A segmented regression analysis also demonstrated differences in rates of change before and after guidelines, with significant improvement for chest radiography, steroids, and bronchodilators (P < .0001).
Conclusions:
In a nationally representative cohort of pediatric hospitals, publication of the 2006 American Academy of Pediatrics bronchiolitis guidelines was associated with significant reductions in the use of diagnostic and therapeutic resources.
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