A Multicenter Collaborative to Reduce Unnecessary Care in Inpatient Bronchiolitis Shawn L. Ralston, MD, MS, a Matthew D. Garber, MD, b Elizabeth Rice-Conboy, MS, c Grant M. Mussman, MD, MHSA, d Kristin A. Shadman, MD, e Susan C. Walley, MD, f Elizabeth Nichols, MS, g the Value in Inpatient Pediatrics Network Quality Collaborative for Improving Hospital Compliance with the AAP Bronchiolitis Guideline (BQIP) a Children’s Hospital at Dartmouth, Lebanon, New Hampshire; b University of South Carolina School of Medicine, Columbia, South Carolina; c American Academy of Pediatrics, Chicago, Illinois; d Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio; e American Family Children’s Hospital, Madison, Wisconsin; f University of Alabama, Birmingham, Alabama; and g The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, New Hampshire Dr Ralston conceptualized the project and codirected its implementation, coordinated and critically reviewed all analyses, and drafted the initial manuscript; Dr Garber conceptualized the project and codirected its implementation and critically reviewed and revised the manuscript; Ms Rice-Conboy coordinated all aspects of project design, implementation, and data collection and critically reviewed and revised the manuscript; Drs Mussman, Shadman, and Walley provided project leadership and content, performed a portion of the analysis, and critically reviewed and revised the manuscript; Ms Nichols performed the analyses, prepared all tables and figures, and critically reviewed the manuscript; and all authors approved the final manuscript as submitted. DOI: 10.1542/peds.2015-0851 Accepted for publication Jun 19, 2015 Address correspondence to Shawn L. Ralston, MD, Children’s Hospital at Dartmouth, 1 Medical Dr, Lebanon, NH 03745. E-mail: shawn.l.ralston@ dartmouth.edu PEDIATRICS (ISSN Numbers: Print, 0031-4005; Online, 1098-4275). Copyright © 2016 by the American Academy of Pediatrics Acute viral bronchiolitis represents one of the most frustrating care conundrums in pediatrics. No therapy has proven particularly useful, and evidence for overuse of unnecessary therapy is widely available. 1–9 In response, the American Academy of Pediatrics (AAP) published a clinical practice guideline with the intention to improve the care of bronchiolitis. 10,11 Furthermore, many institutions have published their own experience in reducing unnecessary care by using local guidelines and other quality improvement (QI) methods. 12–25 Most published QI work has been accomplished in academic children’s hospitals, whereas the large majority abstract BACKGROUND AND OBJECTIVE: Evidence-based gGuidelines for acute viral bronchiolitis recommend primarily supportive care, but unnecessary care remains well documented. Published quality improvement work has been accomplished inchildren’s hospitals, but little broad dissemination has been reported outside of those settings. We sought to use a voluntary collaborative strategy to disseminatebest practices to reduce overuse of unnecessary care in children hospitalized for bronchiolitis in community settings. METHODS: This project was aquality improvement collaborative consisting of monthly interactive webinars with online data collection and feedback. Data were collected by chart review for 2 bronchiolitis seasons, defined as January, February, and March of 2013 and 2014. Patients aged <24 months hospitalized for bronchiolitis and without chronic illness, prematurity, or intensive care use were included. Results were analyzed using run charting, analysis of means, and nonparametric statistics. RESULTS: There were 21 participating hospitals contributing a total of 1869 chart reviews to the project, 995 preintervention and 874 postintervention. Mean use of any bronchodilator declined by 29% (P = .03) and doses per patient decreased 45% (P < .01). Mean use of any steroids declined by 68% (P < .01), and doses per patient decreased 35% (P = .04). Chest radiography use declined by 44% (P = .05). Length of stay decreased 5 hours (P < .01), and readmissions remained unchanged. CONCLUSIONS: A voluntary collaborative was effective in reducing unnecessary care among a cohort of primarily community hospitals. Such a strategy may be generalizable to the settings where the majority of children are hospitalized in the United States. QUALITY REPORT PEDIATRICS Volume 137, number 1, January 2016:e20150851 To cite: Ralston SL, Garber MD, Rice-Conboy E, et al. A Multicenter Collaborative to Reduce Unnecessary Care in Inpatient Bronchiolitis. Pediatrics. 2016;137(1):e20150851 by guest on April 25, 2016 Downloaded from