Factors Associated With Bronchiolitis Guideline Nonadherence at US Children's Hospitals

Area of Science:

• Pediatric Emergency Medicine
• Clinical Guidelines
• Healthcare Quality Improvement

Background:

• Bronchiolitis is a common respiratory infection in infants and young children.
• National guidelines exist to standardize bronchiolitis care.
• Nonadherence to these guidelines can lead to variations in treatment and outcomes.

Purpose of the Study:

• To investigate factors contributing to nonadherence to national bronchiolitis guidelines.
• To analyze variations in adherence across different patient demographics and hospital settings.
• To identify specific tests and treatments associated with guideline nonadherence.

Main Methods:

• Retrospective analysis of 198,028 patient encounters for bronchiolitis.
• Inclusion of emergency department (ED) and inpatient admissions from January 2016 to December 2018.
• Logistic regression modeling to identify factors associated with nonadherence, defined by receiving specific tests/treatments (bronchodilators, chest radiographs, steroids, antibiotics, viral testing).

Main Results:

• Overall nonadherence rate was 46.1% (40.2% in ED, 61.0% in admissions).
• Older children (12-24 months) were more likely to receive nonadherent care compared to younger infants (1-2 months).
• Admitted non-Hispanic Black patients received more nonadherent care, particularly steroids and bronchodilators, compared to non-Hispanic white patients.

Conclusions:

• Patient age and race are significant factors associated with bronchiolitis guideline nonadherence.
• Hospital-level variations also contribute to nonadherence, particularly for viral testing.
• Addressing these factors may improve adherence and standardize bronchiolitis care.