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Impact of a Bronchiolitis Clinical Pathway on Management Decisions by Preferred Language
Robert H Rosen1, Michael C Monuteaux1, Anne M Stack1
1From the Division of Emergency Medicine, Boston Children's Hospital, Boston, Mass.
Insights
A clinical pathway improved bronchiolitis care for all patients. However, albuterol use decreased more significantly in non-English speaking groups, suggesting potential disparities in medication management.
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.
Background:
Clinical pathways standardize healthcare utilization, but their impact on healthcare equity is poorly understood. This study aims to measure the effect of a bronchiolitis pathway on management decisions by preferred language for care.
Methods:
We included all emergency department encounters for patients aged 1-12 months with bronchiolitis from 1/1/2010 to 10/31/2020. The prepathway period ended 10/31/2011, and the postpathway period was 1/1/2012-10/31/2020. We performed retrospective interrupted time series analyses to assess the impact of the clinical pathway by English versus non-English preferred language on the following outcomes: chest radiography (CXR), albuterol use, 7-day return visit, 72-hour return to admission, antibiotic use, and corticosteroid use. Analyses were adjusted for presence of a complex chronic condition.
Results:
There were 1485 encounters in the preperiod (77% English, 14% non-English, 8% missing) and 7840 encounters in the postperiod (79% English, 15% non-English, 6% missing). CXR, antibiotic, and albuterol utilization exhibited sustained decreases over the study period. Pathway impact did not differ by preferred language for any outcome except albuterol utilization. The prepost slope effect of albuterol utilization was 10% greater in the non-English versus the English group (p for the difference by language = 0.022).
Conclusions:
A clinical pathway was associated with improvements in care regardless of preferred language. More extensive studies involving multiple pathways and care settings are needed to assess the impact of clinical pathways on health equity.
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