Unnecessary Care for Bronchiolitis Decreases With Increasing Inpatient Prevalence of Bronchiolitis

OBJECTIVE: To measure the association between inpatient bronchiolitis prevalence (IBP) and the delivery of unnecessary tests and treatments to patients hospitalized with bronchiolitis. METHODS: A multicenter, retrospective, cohort study was performed using the Pediatric Hospital Information System database. All patients 2 months to 2 years of age hospitalized with bronchiolitis during 2004-2008 at participating pediatric hospitals were included. Main outcome measures were the probability of receiving potentially unnecessary care for bronchiolitis, including steroids, intravenously administered antibiotics, chest or neck radiographs, and any laboratory tests during hospitalization. RESULTS: During winter months, with each 1% absolute increase in IBP, patients were less likely to receive steroids (incidence rate ratio: 0.968 [95% confidence interval: 0.960-0.976]; P<.001), radiographs (incidence rate ratio: 0.988 [95% confidence interval: 0.984-0.992]; P<.001), and laboratory tests (incidence rate ratio: 0.992 [95% confidence interval: 0.988-0.995]; P<.001). During summer months, similar associations were observed for steroids and radiographs. No association between IBP and antibiotic use was observed during either time period. CONCLUSIONS: The frequency with which several types of unnecessary care were delivered to patients with bronchiolitis seemed to decrease with increasing IBP. This finding suggests that an association exists between contextual information and care delivery during the management of acute illness, and it highlights the importance of such information for delivery of high-quality health care. Pediatrics 2011; 128: e1106-e1112