Impact of a bronchiolitis guideline: a multisite demonstration project.
OBJECTIVE
The purpose of this study was to determine the impact of a multisite implementation of an evidence-based clinical practice guideline for bronchiolitis.


METHODS
Before and after study.


METHODS
Eleven Child Health Accountability Initiative (CHAI) study hospitals.


METHODS
Children < 12 months of age with a first-time episode of bronchiolitis.


METHODS
The guideline was implemented in December 1998. Complete preimplementation and postimplementation administrative data on hospital admissions, resource utilization, and length of stay were available from seven study hospitals. At five sites, chart reviews were conducted for data on the number and type of bronchodilators used.


RESULTS
Complete administrative data were available for 846 historical control subjects and 792 study patients. Length of stay decreased significantly. While the proportion of eligible patients who received any bronchodilator did not change (84%), the proportion of patients who received albuterol decreased from 80 to 75% after guideline implementation (p < 0.03). For patients who received bronchodilators, the mean (+/- SD) number of doses decreased from 13.6 +/- 14.0 to 7.3 +/- 9.1 doses (p < 0.0001). For patients who received albuterol, the mean number of doses decreased from 12.8 +/- 11.8 to 6.4 +/- 7.8 doses (p < 0.0001). Other resource use decreased modestly. Hospital readmission rates within 7 days of discharge were unchanged.


CONCLUSIONS
We successfully extended the implementation of an evidence-based clinical practice guideline from one hospital to seven hospitals. Within just a single bronchiolitis season, some significant changes in practice were seen. The multisite CHAI collaborative appears to be a promising laboratory for large-scale quality improvement initiatives.
Kotagal
Uma R
UR
Health Policy and Clinical Effectiveness Program, Children's Hospital Medical Center, Cincinnati, OH 45229-3039, USA. KOTK9J@chmcc.org
Robbins
James M
JM
Kini
Narendra M
NM
Schoettker
Pamela J
PJ
Atherton
Harry D
HD
Kirschbaum
Mark S
MS
D001988:Bronchiolitis / Q000628:therapy*; D001993:Bronchodilator Agents / Q000627:therapeutic use; D019983:Guideline Adherence; D006801:Humans; D007223:Infant
D001993:Bronchodilator Agents