Collaborative Approach Reduces Unneeded Bronchiolitis Care

Lara C. Pullen, PhD

December 10, 2015

A voluntary quality improvement program may help community hospitals reduce unnecessary care for bronchiolitis, and may be especially useful for managing the treatment of hospitalized children, according to a report published online December 1 in Pediatrics.

"We focused on enrolling community hospitals with the aim of establishing that successful dissemination of known best practices could be accomplished in a real-world setting with primarily volunteer participants," write Shawn Ralston, MD, from Children's Hospital at Dartmouth in Lebanon, New Hampshire, and colleagues.

The program included 21 hospitals for a total of 1869 chart reviews (995 preintervention and 874 postintervention). Participating hospitals entered their own data and performed their own chart reviews.

The 1-year virtual collaborative program did not have a specific theoretical basis. Instead, webinars, teleconferences, and project Listserv were designed to implement a care package.

The intervention was able to decrease the mean use of any bronchodilator by 29% (P = .03) and decreased doses per patient by 45% (P < .01). Mean steroid use declined by 68%, and mean doses of steroid per patient decreased by 35% (P = .04). Chest radiography use decreased by 44% (P = .05).

The length of stay decreased by 5 hours (P < .01), whereas the readmission rate remained unchanged. The results mirror those reported by a similar project targeted at reducing resource use in bronchiolitis.

These reductions in overuse of unnecessary care were achieved in the majority of participating sites.

Two sites, however, significantly increased the use of albuterol, and three sites significantly increased the use of steroids. The team is currently performing in-depth qualitative interviews to determine which factors might contribute to the disparate outcomes.

"The most striking characteristic of our project was the primary focus on discontinuation of unnecessary therapies (with the exception of tobacco cessation counseling). There is a paucity of QI work on exactly how to reduce unnecessary care, and 'deimplementation' is a newly coined term. On the basis of our experience in this collaborative and a previous iteration, we hypothesize that sharing experience in a collaborative has a specific value in reducing unnecessary care in its effect on establishing normative behavior among a peer group," the authors write.

This project was funded in part by the American Academy of Pediatrics Friends of Children Fund. The authors have disclosed no relevant financial relationships.

Pediatrics. Published online December 1, 2015. Abstract


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