Group-facilitated audit and feedback to improve bronchiolitis care in the emergency department.

Autor:	Dowling SK; Physician Learning Program, Continuing Medical Education and Professional Development, Cumming School of Medicine, University of Calgary, Calgary, AB.; Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB.; Department of Emergency Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB., Gjata I; Physician Learning Program, Continuing Medical Education and Professional Development, Cumming School of Medicine, University of Calgary, Calgary, AB., Solbak NM; Physician Learning Program, Continuing Medical Education and Professional Development, Cumming School of Medicine, University of Calgary, Calgary, AB., Weaver CGW; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB.; Health Services Statistical and Analytic Methods, Analytics, Alberta Health Services, Edmonton, AB., Smart K; Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB., Buna R; Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB., Stang AS; Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB.; Department of Emergency Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB.; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB.
Jazyk:	angličtina
Zdroj:	CJEM [CJEM] 2020 Sep; Vol. 22 (5), pp. 678-686.
DOI:	10.1017/cem.2020.374
Abstrakt:	Objective: Despite strong evidence recommending supportive care as the mainstay of management for most infants with bronchiolitis, prior studies show that patients still receive low-value care (e.g., respiratory viral testing, salbutamol, chest radiography). Our objective was to decrease low-value care by delivering individual physician reports, in addition to group-facilitated feedback sessions to pediatric emergency physicians. Methods: Our cohort included 3,883 patients ≤ 12 months old who presented to pediatric emergency departments in Calgary, Alberta, with a diagnosis of bronchiolitis from April 1, 2013, to April 30, 2018. Using administrative data, we captured baseline characteristics and therapeutic interventions. Consenting pediatric emergency physicians received two audit and feedback reports, which included their individual data and peer comparators. A multidisciplinary group-facilitated feedback session presented data and identified barriers and enablers of reducing low-value care. The primary outcome was the proportion of patients who received any low-value intervention and was analysed using statistical process control charts. Results: Seventy-eight percent of emergency physicians consented to receive their audit and feedback reports. Patient characteristics were similar in the baseline and intervention period. Following the baseline physician reports and the group feedback session, low-value care decreased from 42.6% to 27.1% (absolute difference: -15.5%; 95% CI: -19.8% to -11.2%) and 78.9% to 64.4% (absolute difference: -14.5%; 95% CI: -21.9% to -7.2%) in patients who were not admitted and admitted, respectively. Balancing measures, such as intensive care unit admission and emergency department revisit, were unchanged. Conclusion: The combination of audit and feedback and a group-facilitated feedback session reduced low-value care for patients with bronchiolitis.
Databáze:	MEDLINE
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