Do the Guidelines Apply?-A Multisite, Combined Stakeholder Qualitative Case Study to Understand Care Decisions in...

Area of Science:

• Pediatric healthcare research
• Clinical practice guideline implementation
• Health services research

Background:

• Clinical practice guidelines for bronchiolitis recommend against unnecessary tests and treatments.
• Despite recommendations, most admitted children receive interventions that do not improve outcomes.
• Understanding stakeholder factors is crucial for de-implementing unnecessary care.

Purpose of the Study:

• To explore healthcare provider and parent perspectives on bronchiolitis testing and treatment.
• To develop a combined stakeholder account of care decisions.
• To identify factors influencing the adoption of evidence-based practices.

Main Methods:

• Qualitative case study across two children's hospitals (low vs. high utilization).
• 46 semi-structured interviews and 3 focus groups with 74 participants (providers, care teams, parents).
• Applied thematic analysis with triangulation of findings across participant groups and methods.

Main Results:

• Key themes: guideline awareness, perceptions of expected tests/treatments, and organizational culture.
• Providers cited parent expectations for tests/treatments as a driver of utilization.
• Parents reported no expectations for tests/treatments and that they did not improve care experience.

Conclusions:

• Illuminated factors influencing differential adoption of evidence-based bronchiolitis care.
• Identified targets for future de-implementation strategies.
• Parents desire an evidence-based, less-is-more approach, contrary to provider perceptions.