A Multicenter Collaborative to Improve Care of Community Acquired Pneumonia in Hospitalized Children.
OBJECTIVE
The Value in Inpatient Pediatrics Network sponsored the Improving Care in Community Acquired Pneumonia collaborative with the goal of increasing evidence-based management of children hospitalized with community acquired pneumonia (CAP). Project aims included: increasing use of narrow-spectrum antibiotics, decreasing use of macrolides, and decreasing concurrent treatment of pneumonia and asthma.


METHODS
Data were collected through chart review across emergency department (ED), inpatient, and discharge settings. Sites reviewed up to 20 charts in each of 6 3-month cycles. Analysis of means with 3-σ control limits was the primary method of assessment for change. The expert panel developed project measures, goals, and interventions. A change package of evidence-based tools to promote judicious use of antibiotics and raise awareness of asthma and pneumonia codiagnosis was disseminated through webinars. Peer coaching and periodic benchmarking were used to motivate change.


RESULTS
Fifty-three hospitals enrolled and 48 (91%) completed the 1-year project (July 2014-June 2015). A total of 3802 charts were reviewed for the project; 1842 during baseline cycles and 1960 during postintervention cycles. The median before and after use of narrow-spectrum antibiotics in the collaborative increased by 67% in the ED, 43% in the inpatient setting, and 25% at discharge. Median before and after use of macrolides decreased by 22% in the ED and 27% in the inpatient setting. A decrease in asthma and CAP codiagnosis was noted, but the change was not sustained.


CONCLUSIONS
Low-cost strategies, including collaborative sharing, peer benchmarking, and coaching, increased judicious use of antibiotics in a diverse range of hospitals for pediatric CAP.
Division of Hospital Medicine, Children's National Health System, and George Washington University School of Medicine, Washington, District of Columbia; kparikh@childrensnational.org.
Kavita
K
Parikh
Department of Pediatrics, University of Rochester Medical Center, Rochester, New York.
Eric
E
Biondi
Children's Hospital at Montefiore, Bronx, New York.
Joanne
J
Nazif
American Academy of Pediatrics, Elk Grove Village, Illinois.
Faiza
F
Wasif
Department of Pediatrics, Monroe Carell Jr. Children's Hospital at Vanderbilt and Vanderbilt University School of Medicine, Nashville, Tennessee.
Derek J
DJ
Williams
Dartmouth Institute for Health Policy and Clinical Effectiveness, Lebanon, New Hampshire; and.
Elizabeth
E
Nichols
Department of Pediatrics, Geisel School of Medicine at Children's Hospital at Dartmouth, Lebanon, New Hampshire.
Shawn
S
Ralston
D000293:Adolescent; D000658:Amoxicillin / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001249:Asthma / Q000453:epidemiology; D019985:Benchmarking; D002648:Child; D002675:Child, Preschool; D017714:Community-Acquired Infections / Q000188:drug therapy / Q000453:epidemiology; D003299:Cooperative Behavior; D004363:Drug Utilization / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital; D006760:Hospitalization; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D018942:Macrolides / Q000627:therapeutic use; D010154:Pakistan; D010406:Penicillins / Q000627:therapeutic use; D011014:Pneumonia / Q000188:drug therapy* / Q000453:epidemiology; D058996:Quality Improvement / Q000458:organization & administration*; D014481:United States
D000900:Anti-Bacterial Agents; D018942:Macrolides; D010406:Penicillins; D000658:Amoxicillin