Decreasing unnecessary utilization in acute bronchiolitis care: Results from the value in inpatient pediatrics network

被引：68

作者：

Ralston, Shawn ^{[1
]}

Garber, Matthew ^{[2
]}

Narang, Steve ^{[3
]}

Shen, Mark ^{[4
]}

Pate, Brian ^{[5
]}

Pope, John ^{[6
]}

Lossius, Michele ^{[7
]}

Croland, Trina ^{[8
]}

Bennett, Jeff ^{[9
]}

Jewell, Jennifer ^{[10
]}

Krugman, Scott ^{[11
]}

Robbins, Elizabeth ^{[12
]}

Nazif, Joanne ^{[13
]}

Liewehr, Sheila ^{[13
]}

Miller, Ansley ^{[14
]}

Marks, Michelle ^{[15
]}

Pappas, Rita ^{[15
]}

Pardue, Jeanann ^{[16
]}

Quinonez, Ricardo ^{[17
,18
]}

Fine, Bryan R. ^{[19
]}

Ryan, Michael ^{[20
]}

机构：

[1] Univ Texas Hlth Sci Ctr San Antonio, Div Inpatient Pediat, Dept Pediat, San Antonio, TX 78229 USA

[2] Univ S Carolina, Dept Pediat, Columbia, SC 29208 USA

[3] Banner Hlth Syst, Cardon Childrens Med Ctr, Mesa, AZ USA

[4] Dell Childrens Hosp, Pediat Consultat & Referral Serv, Austin, TX USA

[5] Childrens Mercy Hosp, Sect Pediat Hosp Med, Dept Pediat, Kansas City, MO 64108 USA

[6] Scottsdale Healthcare Hosp Syst, Shea Pediat Dept, Scottsdale, AZ USA

[7] Univ Florida, Dept Pediat, Shands Hosp Children, Gainesville, FL USA

[8] Univ Illinois, Dept Pediat, Childrens Hosp Illinois, Chicago, IL USA

[9] Univ Kentucky, Coll Med, Dept Pediat, Kentucky Childrens Hosp, Lexington, KY USA

[10] Barbara Bush Childrens Hosp, Dept Pediat, Portland, ME USA

[11] Franklin Sq Hosp Ctr, Dept Pediat, Baltimore, MD USA

[12] Anne Arundel Med Ctr, Annapolis, MD USA

[13] Childrens Hosp Montefiore, Dept Pediat, Bronx, NY USA

[14] Mission Childrens Hosp, Asheville, NC USA

[15] Cleveland Clin, Childrens Hosp, Cleveland, OH 44106 USA

[16] E Tennessee Childrens Hosp, Knoxville, TN USA

[17] Texas Childrens Hosp, Houston, TX 77030 USA

[18] Baylor Coll Med, Houston, TX 77030 USA

[19] Childrens Hosp Kings Daughters, Norfolk, VA USA

[20] Childrens Hosp Richmond, Richmond, VA USA

来源：

JOURNAL OF HOSPITAL MEDICINE | 2013年 / 8卷 / 01期

关键词：

EVIDENCE-BASED GUIDELINE; EMERGENCY-DEPARTMENTS; QUALITY IMPROVEMENT; MANAGEMENT; INFANTS; HOSPITALIZATIONS; HOSPITALISTS; THERAPIES; IMPACT;

D O I：

10.1002/jhm.1982

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

BACKGROUND: Acute viral bronchiolitis is the most common diagnosis resulting in hospital admission in pediatrics. Utilization of nonevidence-based therapies and testing remains common despite a large volume of evidence to guide quality improvement efforts. OBJECTIVE: Our objective was to reduce utilization of unnecessary therapies in the inpatient care of bronchiolitis across a diverse network of clinical sites. METHODS: We formed a voluntary quality improvement collaborative of pediatric hospitalists for the purpose of benchmarking the use of bronchodilators, steroids, chest radiography, chest physiotherapy, and viral testing in bronchiolitis using hospital administrative data. We shared resources within the network, including protocols, scores, order sets, and key bibliographies, and established group norms for decreasing utilization. RESULTS: Aggregate data on 11,568 hospitalizations for bronchiolitis from 17 centers was analyzed for this report. The network was organized in 2008. By 2010, we saw a 46% reduction in overall volume of bronchodilators used, a 3.4 dose per patient absolute decrease in utilization (95% confidence interval [CI] 1.45.8). Overall exposure to any dose of bronchodilator decreased by 12 percentage points as well (95% CI 5%25%). There was also a statistically significant decline in chest physiotherapy usage, but not for steroids, chest radiography, or viral testing. CONCLUSIONS: Benchmarking within a voluntary pediatric hospitalist collaborative facilitated decreased utilization of bronchodilators and chest physiotherapy in bronchiolitis. Journal of Hospital Medicine 2013. (c) 2012 Society of Hospital Medicine

引用

页码：25 / 30

页数：6

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