Improving Management of Bronchiolitis Across a Primary Care Network

Area of Science:

• Pediatric respiratory illness management.
• Quality improvement in primary care.

Background:

• Bronchiolitis is a common respiratory illness in young children.
• Pharmacotherapy for mild bronchiolitis lacks proven efficacy, yet overuse persists in primary care.

Purpose of the Study:

• To reduce bronchodilator use in pediatric bronchiolitis from 24% to 15% within a primary care network.
• To maintain steroid use at 7% during the quality improvement initiative.

Main Methods:

• Implementation of a clinical algorithm and electronic health record enhancements across 39 clinics.
• Utilized Plan-Do-Study-Act cycles, including stakeholder engagement, data feedback, and provider incentives.
• Monitored bronchodilator and steroid use, respiratory score documentation, and 7-day return visit rates.

Main Results:

• Albuterol use decreased from 24% to 11%; steroid use dropped from 7% to 1%.
• Respiratory score documentation did not improve.
• The percentage of return visits within 7 days decreased from 10% to 8%.

Conclusions:

• Data transparency, provider scorecards, and care standardization drove compliance and improvement in a learning health system.
• Primary care engagement was crucial for the success of this quality initiative aimed at improving pediatric outcomes.