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Associations Between Quality Measures and Outcomes for Children Hospitalized With Bronchiolitis

Mersine A Bryan1,2, Amy Tyler3, Chuan Zhou4,2

  • 1Department of Pediatrics, University of Washington, Seattle, Washington; mersine@uw.edu.

Hospital Pediatrics
|October 27, 2020
PubMed

Insights

Reducing unnecessary lab tests for bronchiolitis is linked to shorter hospital stays and lower costs. Adherence to specific Pediatric Respiratory Illness Measurement System (PRIMES) indicators can improve care quality.

Area of Science:

  • Pediatric Medicine
  • Healthcare Quality Improvement
  • Health Economics

Background:

  • Bronchiolitis is a common pediatric respiratory illness.
  • Current quality metrics for bronchiolitis care vary.
  • The Pediatric Respiratory Illness Measurement System (PRIMES) offers indicators for evaluating care.

Purpose of the Study:

  • To assess the association between adherence to individual PRIMES indicators and healthcare outcomes for pediatric bronchiolitis.
  • To determine if specific PRIMES indicators correlate with reduced length of stay (LOS) and cost.

Main Methods:

  • Prospective enrollment of 699 children with bronchiolitis across 5 children's hospitals (2014-2016).
  • Evaluation of 16 PRIMES indicators (9 overuse, 7 underuse) for their association with LOS and cost.
  • Mixed-effects linear regression analysis, controlling for patient and hospital factors.

Main Results:

  • Three overuse indicators (no blood cultures, no complete blood cell counts, no respiratory syncytial virus testing) were significantly associated with shorter LOS and lower costs.
  • No blood cultures showed the largest reduction in LOS (-24.3 hours) and cost (-$731).
  • Two underuse indicators (documentation of oral intake and hospital follow-up at discharge) were linked to increased costs.

Conclusions:

  • A subset of PRIMES quality indicators for bronchiolitis demonstrates strong associations with improved patient outcomes.
  • These indicators can be valuable for future quality improvement initiatives in pediatric bronchiolitis care.
  • Focusing on reducing unnecessary laboratory testing may lead to significant cost savings and shorter hospitalizations.
Abstract

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