The Evolution of Quality Benchmarks for Bronchiolitis.

Area of Science:

• Pediatric healthcare quality improvement
• Respiratory illness management
• Clinical guideline implementation

Background:

• Average performance on bronchiolitis quality measures is improving.
• Optimal performance benchmarks (ABCs) for bronchiolitis care are not well-defined over time.
• Understanding changes in ABCs is crucial for setting realistic quality improvement targets.

Purpose of the Study:

• To compare Achievable Benchmarks of Care (ABCs) for bronchiolitis quality measures across two distinct time periods.
• To evaluate performance gaps between median performance and ABCs for targeted quality initiatives.
• To assess the impact of national guidelines on bronchiolitis care quality.

Main Methods:

• Utilized the Pediatric Health Information System database for hospital administrative data.
• Calculated ABCs and performance gaps for nonrecommended bronchiolitis interventions.
• Analyzed data for emergency department (ED) and hospitalized patients across 2006-2014 and 2014-2019 periods.

Main Results:

• Significant improvements in ABCs observed for chest radiography, viral testing, antibiotic use, and bronchodilator use.
• Largest performance gaps identified for viral testing (ED and hospitalized) and bronchodilator use (ED and hospitalized).
• Confidence intervals indicate statistically significant changes in benchmarks and gaps.

Conclusions:

• Achievable Benchmarks of Care (ABCs) for bronchiolitis quality measures have evolved, necessitating reevaluation of improvement targets.
• Ongoing quality improvement initiatives should focus on measures with substantial performance gaps, particularly bronchodilator use and viral testing.
• Adapting quality targets to evolving practice patterns is essential for effective healthcare quality management.