Impact of a Bronchiolitis Clinical Pathway on Management Decisions by Preferred Language

Area of Science:

• Pediatric Emergency Medicine
• Health Services Research
• Health Equity

Background:

• Clinical pathways aim to standardize healthcare delivery.
• The impact of clinical pathways on healthcare equity remains under-examined.
• This study investigates a bronchiolitis pathway's effect on management decisions based on preferred language.

Purpose of the Study:

• To evaluate the impact of a clinical pathway for bronchiolitis on healthcare management.
• To determine if the pathway's effect on management decisions differs by patients' preferred language for care.

Main Methods:

• Retrospective interrupted time series analysis of emergency department encounters for patients aged 1-12 months with bronchiolitis.
• Comparison of pre-pathway (10/2010-10/2011) and post-pathway (01/2012-10/2020) periods.
• Outcomes assessed included chest radiography, albuterol use, return visits, hospital admission after return, antibiotic use, and corticosteroid use, adjusted for chronic conditions.

Main Results:

• Overall utilization of chest radiography, antibiotics, and albuterol decreased post-pathway implementation.
• The clinical pathway's impact on most outcomes did not vary by preferred language.
• A notable exception was albuterol utilization, which showed a greater decrease in non-English preferred language patients compared to English preferred language patients (p=0.022).

Conclusions:

• The implemented clinical pathway generally improved care for pediatric bronchiolitis patients, irrespective of their preferred language.
• While overall care improved, the differential impact on albuterol utilization warrants further investigation regarding health equity.
• Additional research across diverse pathways and settings is recommended to fully understand the implications for health equity.