Related Experiment Video
Updated: Nov 9, 2025
Assessment of the Efficacy of An Osteopathic Treatment in Infants with Biomechanical Impairments to Suckling
Published on: February 5, 2019
Effectiveness of Targeted Interventions on Treatment of Infants With Bronchiolitis: A Randomized Clinical Trial
Libby Haskell1, Emma J Tavender2,3, Catherine L Wilson2
1Children's Emergency Department, Starship Children's Hospital, Auckland, New Zealand.
Insights
Targeted interventions significantly improved adherence to evidence-based bronchiolitis care in infants, reducing non-evidence-based therapies. This research advances deimplementation science for better pediatric care.
Area of Science:
- Pediatric hospital medicine
- Deimplementation science
- Evidence-based practice
Background:
- Bronchiolitis is a leading cause of infant hospitalization in developed nations.
- International guidelines recommend supportive care, yet non-evidence-based therapies persist.
- Deimplementation research is crucial for reducing low-value care.
Purpose of the Study:
- To compare the effectiveness of targeted interventions versus passive guideline dissemination.
- To improve the treatment of infants with bronchiolitis based on evidence.
Main Methods:
- International, multicenter cluster randomized trial in 26 Australian and New Zealand hospitals.
- Interventions utilized behavior change theories and included clinical leads, workshops, and audit/feedback.
- Primary outcome: compliance with no chest radiography, albuterol, glucocorticoids, antibiotics, or epinephrine within 24 hours.
Main Results:
- Compliance with evidence-based care was significantly higher in intervention hospitals (85.1%) versus control hospitals (73.0%).
- The adjusted risk difference for compliance was 14.1% (P < .001).
- No patient-level exclusions; analysis by intention to treat.
Conclusions:
- Targeted interventions effectively improved bronchiolitis management in infants.
- This study provides a model for deimplementing low-value care in pediatric settings.
- Findings have significant implications for clinical practice and healthcare policy.
Importance:
In developed countries, bronchiolitis is the most common reason for infants to be admitted to the hospital, and all international bronchiolitis guidelines recommend supportive care; however, significant variation in practice continues with infants receiving non-evidence-based therapies. Deimplementation research aims to reduce the use of low-value care, and advancing science in this area is critical to delivering evidence-based care.
Objective:
To determine the effectiveness of targeted interventions vs passive dissemination of an evidence-based bronchiolitis guideline in improving treatment of infants with bronchiolitis.
Design, Setting, And Participants:
This international, multicenter cluster randomized clinical trial included 26 hospitals (clusters) in Australia and New Zealand providing tertiary or secondary pediatric care (13 randomized to intervention, 13 to control) during the 2017 bronchiolitis season. Data were collected on 8003 infants for the 3 bronchiolitis seasons (2014-2016) before the implementation period and 3727 infants for the implementation period (2017 bronchiolitis season, May 1-November 30). Data were analyzed from November 16, 2018, to December 9, 2020.
Interventions:
Interventions were developed using theories of behavior change to target key factors that influence bronchiolitis management. These interventions included site-based clinical leads, stakeholder meetings, a train-the-trainer workshop, targeted educational delivery, other educational and promotional materials, and audit and feedback.
Main Outcomes And Measures:
The primary outcome was compliance during the first 24 hours of care with no use of chest radiography, albuterol, glucocorticoids, antibiotics, and epinephrine, measured retrospectively from medical records of randomly selected infants with bronchiolitis who presented to the hospital. There were no patient-level exclusions.
Results:
A total of 26 hospitals were randomized without dropouts. Analysis was by intention to treat. Baseline data collected on 8003 infants for 3 bronchiolitis seasons (2014-2016) before the implementation period were similar between intervention and control hospitals. Implementation period data were collected on 3727 infants, including 2328 boys (62%) and 1399 girls (38%), with a mean (SD) age of 6.0 (3.2) months. A total of 459 (12%) were Māori (New Zealand), and 295 (8%) were Aboriginal/Torres Strait Islander (Australia). Compliance with recommendations was 85.1% (95% CI, 82.6%-89.7%) in intervention hospitals vs 73.0% (95% CI, 65.3%-78.8%) in control hospitals (adjusted risk difference, 14.1%; 95% CI, 6.5%-21.7%; P < .001).
Conclusions And Relevance:
Targeted interventions led to improved treatment of infants with bronchiolitis. This study has important implications for bronchiolitis management and the development of effective interventions to deimplement low-value care.
Trial Registration:
Australian and New Zealand Clinical Trials Registry: ACTRN12616001567415.
Related Concept Videos
01:26COPD: Management Using Bronchodilators and Corticosteroids
01:23Upper Respiratory Drugs: Antitussives, Expectorants, and Mucolytics
Antitussives include codeine, dextromethorphan (Robitussin), and benzonatate (Tessalon). Codeine and dextromethorphan exert their effects centrally by suppressing the cough reflex center in the medulla. Benzonatate operates peripherally within the respiratory tract by...
01:29Acute Respiratory Failure-V
Ensure that patients are monitored continuously for their response to therapy, including changes in...