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Sustainability in the AAP Bronchiolitis Quality Improvement Project
Kristin A Shadman1, Shawn L Ralston2, Matthew D Garber3
1University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA. kshadman@pediatrics.wisc.edu.
Insights
The Bronchiolitis Quality Improvement Project (BQIP) successfully improved adherence to clinical guidelines for pediatric bronchiolitis care. These quality improvements were sustained for one year post-collaboration, demonstrating lasting impact.
Area of Science:
- Pediatrics
- Quality Improvement
- Healthcare Management
Background:
- Adherence to American Academy of Pediatrics (AAP) bronchiolitis guidelines improved via the Bronchiolitis Quality Improvement Project (BQIP).
- The study assesses the sustainability of these improvements one year after the collaborative concluded.
Purpose of the Study:
- To evaluate the long-term maintenance of quality improvements in pediatric bronchiolitis care following a multi-institutional collaborative project.
- To determine if gains in guideline adherence and quality measures persist beyond the active intervention phase.
Main Methods:
- Twenty-one multidisciplinary teams collected monthly data on key inpatient bronchiolitis measures.
- Data from 2275 encounters (995 baseline, 877 intervention, 403 sustainability) were analyzed using generalized linear mixed-effects models.
- Nine sites provided sustainability data one year post-collaboration.
Main Results:
- All key quality measure improvements achieved during the intervention were maintained in the sustainability season.
- Orders for intermittent pulse oximetry significantly increased from 40.6% to 79.2% during the sustainability period.
- Sites participating in the sustainability season showed similar characteristics to those that did not.
Conclusions:
- Participating sites sustained improvements in key bronchiolitis quality measures for one year after the BQIP concluded.
- This collaborative model, providing best-practice toolkits and building local quality improvement capacity, can lead to persistent performance gains.
Background And Objectives:
Adherence to American Academy of Pediatrics (AAP) bronchiolitis clinical practice guideline recommendations improved significantly through the AAP's multiinstitutional collaborative, the Bronchiolitis Quality Improvement Project (BQIP). We assessed sustainability of improvements at participating institutions for 1 year following completion of the collaborative.
Methods:
Twenty-one multidisciplinary hospital-based teams provided monthly data for key inpatient bronchiolitis measures during baseline and intervention bronchiolitis seasons. Nine sites provided data in the season following completion of the collaborative. Encounters included children younger than 24 months who were hospitalized for bronchiolitis without comorbid chronic illness, prematurity, or intensive care. Changes between baseline-, intervention-, and sustainability-season data were assessed using generalized linear mixed-effects models with site-specific random effects. Differences between hospital characteristics, baseline performance, and initial improvement between sites that did and did not participate in the sustainability season were compared.
Results:
A total of 2275 discharges were reviewed, comprising 995 baseline, 877 intervention, and 403 sustainability- season encounters. Improvements in all key bronchiolitis quality measures achieved during the intervention season were maintained during the sustainability season, and orders for intermittent pulse oximetry increased from 40.6% (95% confidence interval [CI], 22.8-61.1) to 79.2% (95% CI, 58.0- 91.3). Sites that did and did not participate in the sustainability season had similar characteristics.
Discussion:
BQIP participating sites maintained improvements in key bronchiolitis quality measures for 1 year following the project's completion. This approach, which provided an evidence-based best-practice toolkit while building the quality-improvement capacity of local interdisciplinary teams, may support performance gains that persist beyond the active phase of the collaborative.
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