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Improving Management of Bronchiolitis Across a Primary Care Network
Andrea V Rivera-Sepulveda1,2, Cara F Harwell1,2, Courtney E Nelson3
1Department of Pediatrics, Division of Emergency Medicine and Urgent Care, Nemours Children's Health, Orlando, Florida.
Insights
Overuse of bronchodilators for pediatric bronchiolitis decreased significantly in primary care. This quality improvement initiative successfully reduced medication use while maintaining positive patient outcomes.
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.
Background And Objective:
Bronchiolitis is the most common respiratory illness in children younger than 2 years. Although pharmacotherapy has not been shown to alter mild disease course, overuse continues in the primary care setting. We sought to improve the management of bronchiolitis in a large primary care network by reducing bronchodilator use from 24% to 15% while maintaining steroid use at 7% within 12 months.
Methods:
Our primary care network is composed of 39 clinics in rural and urban settings across 3 states. Interventions through 4 Plan-Do-Study-Act cycles included (1) stakeholder engagement, education, and implementation of a clinical algorithm with supportive electronic health record enhancements, (2) data sharing and feedback, (3) refinement of documentation, and (4) incentives and automated individual feedback. The outcome measure was bronchodilator and steroid use. The process measure was respiratory score (RS) documentation. The balancing measure was the percentage of return visits within 7 days of the initial primary care visit.
Results:
We included 3158 patients in the baseline and 5465 in the postintervention period. Albuterol use decreased from 24% to 11%. Steroid use decreased from 7% to 1%. The RS documentation did not improve and was not continued. Return visits decreased from 10% to 8%.
Conclusion:
Data transparency, provider scorecards, and standardization of care effectively promoted compliance and improvement through a learning health system within a large primary care network. Primary care's involvement in this quality initiative to improve children's outcomes was key to its success.
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