Decreasing unnecessary utilization in acute bronchiolitis care: Results from the value in inpatient pediatrics network
| Autor: | Jeffrey S. Bennett, Elizabeth Robbins, Sheila Liewehr, Michael Ryan, Ricardo A. Quinonez, John Pope, Brian M. Pate, Shawn L. Ralston, Rita Pappas, Bryan R. Fine, Ansley Miller, Trina Croland, Michelle Marks, Steve Narang, Scott D. Krugman, Joanne Nazif, Matthew D. Garber, Mark W. Shen, jeanann P. pardue, Jennifer A. Jewell, Michele Lossius |
|---|---|
| Rok vydání: | 2012 |
| Předmět: |
medicine.medical_specialty
Pediatrics Quality management Leadership and Management medicine.drug_class MEDLINE Chest physiotherapy Assessment and Diagnosis Bronchodilator medicine Humans Cooperative Behavior Intensive care medicine Care Planning Physical Therapy Modalities Inpatient care business.industry Health Policy Infant General Medicine Hospitals Pediatric medicine.disease Quality Improvement United States Confidence interval Bronchodilator Agents Hospital medicine Benchmarking Interinstitutional Relations Bronchiolitis Evidence-Based Practice Acute Disease Practice Guidelines as Topic Costs and Cost Analysis Radiography Thoracic Steroids Fundamentals and skills Guideline Adherence business |
| Zdroj: | Journal of Hospital Medicine. 8:25-30 |
| ISSN: | 1553-5606 1553-5592 |
| Popis: | BACKGROUND: Acute viral bronchiolitis is the most common diagnosis resulting in hospital admission in pediatrics. Utilization of non–evidence-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] 1.4–5.8). 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. © 2012 Society of Hospital Medicine |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|
Plný text