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Association of Bronchiolitis Clinical Pathway Adherence With Length of Stay and Costs
Mersine A Bryan1,2, Arti D Desai3,2, Lauren Wilson3
1Department of Pediatrics, University of Washington, Seattle, Washington; and mersine@uw.edu.
Insights
High adherence to bronchiolitis clinical pathways significantly reduced length of stay and healthcare costs for pediatric patients. This demonstrates the value of standardized care in improving efficiency and outcomes.
Area of Science:
- Pediatric healthcare research
- Clinical pathway implementation
- Health services research
Background:
- Bronchiolitis is a common pediatric respiratory infection.
- Clinical pathways aim to standardize care and improve outcomes.
- Adherence to clinical pathways can impact healthcare utilization and costs.
Purpose of the Study:
- To evaluate the association between adherence to bronchiolitis clinical pathway recommendations and healthcare use.
- To determine the relationship between adherence levels and associated healthcare costs.
- To analyze the impact of pathway adherence on patient outcomes such as length of stay and readmission rates.
Main Methods:
- Retrospective cohort study of 267 pediatric patients diagnosed with bronchiolitis.
- Clinical pathway adherence assessed using a 0-100 scoring system for 18 quality measures.
- Adherence categorized into low, middle, and high tertiles.
- Generalized linear and logistic regression models used to analyze relationships between adherence and outcomes.
Main Results:
- Higher adherence tertiles were associated with significantly shorter length of stay (LOS) in both ED and inpatient settings.
- Increased adherence correlated with reduced healthcare costs in the emergency department and overall.
- Patients in the highest adherence tertile had a lower odds of hospital admission from the ED.
Conclusions:
- High adherence to bronchiolitis clinical pathway recommendations is linked to improved efficiency.
- Implementing standardized care pathways can lead to reduced length of stay and lower healthcare expenditures.
- Clinical pathways represent a valuable tool for optimizing pediatric respiratory care.
Objectives:
To examine the associations between the level of adherence to bronchiolitis clinical pathway recommendations, health care use, and costs.
Methods:
We conducted a retrospective cohort study of 267 patients ≤24 months old diagnosed with bronchiolitis from 12/2009 to 7/2012. Clinical pathway adherence was assessed by using a standardized scoring system (0-100) for 18 quality measures obtained by medical record review. Level of adherence was categorized into low, middle, and high tertiles. Generalized linear models were used to examine relationships between adherence tertile and (1) length of stay (LOS) and (2) costs. Logistic regression was used to examine the associations between adherence tertile and probability of inpatient admission and 7-day readmissions.
Results:
Mean adherence scores were: ED, 78.8 (SD, 18.1; n = 264), inpatient, 95.0 (SD, 6.3; n = 216), and combined ED/inpatient, 89.1 (SD, 8.1; n = 213). LOS was significantly shorter for cases in the highest versus the lowest adherence tertile (ED, 90 vs 140 minutes, adjusted difference, -51 [95% confidence interval (CI), -73 to -29; P <.05]; inpatient, 3.1 vs 3.8 days, adjusted difference, -0.7 [95% CI, -1.4 to 0.0; P <.05]). Costs were less for cases in the highest adherence tertile (ED, -$84, [95% CI, -$7 to -$161; P <.05], total, -$1296 [95% CI, -126.43 to -2466.03; P <.05]). ED cases in the highest tertile had a lower odds of admission (odds ratio, 0.38 [95% CI, 0.15-0.97; P < .05]). Readmissions did not differ by tertile.
Conclusions:
High adherence to bronchiolitis clinical pathway recommendations across care settings was associated with shorter LOS and lower cost.
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