title: Decreasing unnecessary utilization in acute bronchiolitis care: results from the value in inpatient pediatrics network.
abstract: 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.
authors.affiliation: Department of Pediatrics, Division of Inpatient Pediatrics, University of Texas Health Science Center San Antonio, San Antonio, Texas, USA. Shawn.L.Ralston@hitchcock.org
authors.forename: Shawn
authors.initials: S
authors.lastname: Ralston
authors.forename: Matthew
authors.initials: M
authors.lastname: Garber
authors.forename: Steve
authors.initials: S
authors.lastname: Narang
authors.forename: Mark
authors.initials: M
authors.lastname: Shen
authors.forename: Brian
authors.initials: B
authors.lastname: Pate
authors.forename: John
authors.initials: J
authors.lastname: Pope
authors.forename: Michele
authors.initials: M
authors.lastname: Lossius
authors.forename: Trina
authors.initials: T
authors.lastname: Croland
authors.forename: Jeff
authors.initials: J
authors.lastname: Bennett
authors.forename: Jennifer
authors.initials: J
authors.lastname: Jewell
authors.forename: Scott
authors.initials: S
authors.lastname: Krugman
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Robbins
authors.forename: Joanne
authors.initials: J
authors.lastname: Nazif
authors.forename: Sheila
authors.initials: S
authors.lastname: Liewehr
authors.forename: Ansley
authors.initials: A
authors.lastname: Miller
authors.forename: Michelle
authors.initials: M
authors.lastname: Marks
authors.forename: Rita
authors.initials: R
authors.lastname: Pappas
authors.forename: Jeanann
authors.initials: J
authors.lastname: Pardue
authors.forename: Ricardo
authors.initials: R
authors.lastname: Quinonez
authors.forename: Bryan R
authors.initials: BR
authors.lastname: Fine
authors.forename: Michael
authors.initials: M
authors.lastname: Ryan
mesh_terms: D000208:Acute Disease; D019985:Benchmarking / Q000379:methods / Q000592:standards / Q000706:statistics & numerical data*; D001988:Bronchiolitis / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000191:economics; D001993:Bronchodilator Agents / Q000008:administration & dosage / Q000592:standards* / Q000627:therapeutic use; D003299:Cooperative Behavior; D003365:Costs and Cost Analysis; D055317:Evidence-Based Practice / Q000592:standards* / Q000706:statistics & numerical data; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006776:Hospitals, Pediatric / Q000592:standards / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007373:Interinstitutional Relations; D026741:Physical Therapy Modalities / Q000592:standards / Q000706:statistics & numerical data; D017410:Practice Guidelines as Topic; D058996:Quality Improvement / Q000592:standards / Q000706:statistics & numerical data; D013902:Radiography, Thoracic / Q000706:statistics & numerical data; D013256:Steroids / Q000008:administration & dosage / Q000592:standards* / Q000627:therapeutic use; D014481:United States
chemical_list: D001993:Bronchodilator Agents; D013256:Steroids