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Impact of inpatient bronchiolitis clinical practice guideline implementation on testing and treatment
Vineeta Mittal1, Matt Hall2, Rustin Morse1
1Department of Pediatrics, Children's Medical Center and University of Texas Southwestern Medical Center, Dallas, TX.
Insights
Clinical practice guidelines (CPGs) for bronchiolitis are common but do not reduce test and treatment use. Online accessibility and longer implementation duration of CPGs for bronchiolitis are associated with reduced testing and treatment.
Area of Science:
- Pediatric respiratory infections
- Healthcare quality improvement
- Clinical practice guidelines
Background:
- Bronchiolitis is a common pediatric respiratory infection.
- Variability exists in diagnostic and treatment approaches for bronchiolitis.
- Clinical practice guidelines (CPGs) aim to standardize care.
Purpose of the Study:
- To assess the association between institutional inpatient clinical practice guidelines (CPGs) for bronchiolitis and the utilization of diagnostic tests and treatments.
- To identify factors influencing the effectiveness of CPGs in reducing test and treatment use.
Main Methods:
- A multicenter retrospective cohort study involving infants diagnosed with bronchiolitis.
- Electronic surveys were used to gather data on CPG presence, duration, and implementation methods.
- Statistical analyses, including Wilcoxon rank-sum and multivariable analysis, were performed to compare hospitals with and without CPGs.
Main Results:
- Most hospitals (85%) had a bronchiolitis CPG, with uniform recommendations against routine tests and treatments.
- The mere presence of a CPG was not significantly associated with reduced use of diagnostic tests or treatments.
- Longer CPG implementation duration and online accessibility correlated with significant reductions in specific tests (complete blood count, chest radiography) and corticosteroid use.
Conclusions:
- While most children's hospitals have bronchiolitis CPGs, their presence alone does not significantly decrease test and treatment ordering.
- Effective implementation strategies, including online accessibility and prolonged duration, are crucial for CPGs to impact clinical practice.
- Further research into optimizing CPG implementation is warranted to improve bronchiolitis care.
Objective:
To determine the association between institutional inpatient clinical practice guidelines (CPGs) for bronchiolitis and the use of diagnostic tests and treatments.
Study Design:
A multicenter retrospective cohort study of infants aged 29 days to 24 months with a discharge diagnosis of bronchiolitis was conducted between July 2011 and June 2012. An electronic survey was sent to quality improvement leaders to determine the presence, duration, and method of CPG implementation at participating hospitals. The Wilcoxon rank-sum test was used to perform bivariate comparisons between hospitals with CPGs and those without CPGs. Multivariable analysis was used to determine associations between CPG characteristics and the use of tests and treatments; analyses were clustered by hospital.
Results:
The response rate to our electronic survey was 77% (33 of 43 hospitals). The majority (85%) had an institutional bronchiolitis CPG in place. Hospitals with a CPG had universal agreement regarding recommendations against routine tests and treatments. The presence of a CPG was not associated with significant reductions in the use of tests and treatments (eg, complete blood count, chest radiography, bronchodilator use, steroid and antibiotic use). A longer interval duration since CPG implementation and presence of an easily accessible online CPG document were associated with significant reductions in the performance of complete blood count and chest radiography and the use of corticosteroids. Other implementation factors demonstrated mixed results.
Conclusion:
Most children's hospitals have an institutional bronchiolitis CPG in place. The content of these CPGs is largely uniform in practice recommendations against tests and treatments. The presence of institutional CPGs did not significantly reduce the ordering of tests and treatments. Online accessibility of a written CPG and prolonged duration of implementation reduce tests and treatments.
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