Use of a large national database for comparative evaluation of the effect of a bronchiolitis/viral pneumonia clinical care guideline on patient outcome and resource utilization.

OBJECTIVES To use a large national comparative database to measure the internal effect of a set of evidence-based bronchiolitis/viral pneumonia clinical care guidelines on clinical practice at a children's hospital, and to compare these changes with those at other children's hospitals. DESIGN Prospective cohort study with retrospective and concurrent (other hospital) controls. SETTING The Children's Hospital, Denver, Colo. PARTICIPANTS Hospitalized children with bronchiolitis and/or viral pneumonia. INTERVENTIONS Our clinical guidelines focused on clear admission and discharge criteria, individualized transition-anticipating orders, and "prove it or don't use it" criteria for the use of respiratory syncytial virus testing, bronchodilators, chest physiotherapy, and ribavirin. MAIN OUTCOME MEASURES The effect of guideline implementation was determined by comparative measurement of internal changes in utilization and outcome (nosocomial infection rate) across time and by external comparison with other children's hospitals using standardized data from the Pediatric Health Information System database of the Child Health Corporation of America (Shawnee Mission, Kan). RESULTS Overall, 10 636 bronchiolitis/viral pneumonia cases were studied: 1302 at the index hospital and 9334 at the 7 comparison hospitals. Internally, the index hospital's residents and attending physicians responded favorably to the bronchiolitis/viral pneumonia care guidelines, resulting in decreases in targeted resource utilization. There were no fatalities, and the number of days in the intensive care unit decreased even though the mean severity of admitted cases increased significantly. Targeted utilization was favorably affected, whereas untargeted utilization was not. Nosocomial infections did not increase with a decreased use of respiratory syncytial virus testing. The index hospital differed favorably from other children's hospitals in several categories. CONCLUSION Evidence-based care guidelines can successfully influence utilization and clinical outcome.

[1]  P. Mackie,et al.  Evaluation of an acute point-of-care system screening for respiratory syncytial virus infection. , 2001, The Journal of hospital infection.

[2]  H. Atherton,et al.  Sustaining the implementation of an evidence-based guideline for bronchiolitis. , 2000, Archives of pediatrics & adolescent medicine.

[3]  D. Simmons,et al.  The development of a national agreed minimum diabetes dataset for New Zealand. , 2000, Journal of quality in clinical practice.

[4]  H. Atherton,et al.  Evaluation of an evidence-based guideline for bronchiolitis. , 1999, Pediatrics.

[5]  K. Harvey,et al.  Diagnostic testing for serious bacterial infections in infants aged 90 days or younger with bronchiolitis. , 1999, Archives of pediatrics & adolescent medicine.

[6]  J. Muldoon.  Structure and performance of different DRG classification systems for neonatal medicine. , 1999, Pediatrics.

[7]  D. Bergman.  Evidence-based guidelines and critical pathways for quality improvement. , 1999, Pediatrics.

[8]  G. Marshall,et al.  Standardizing the care of bronchiolitis. , 1998, Archives of pediatrics & adolescent medicine.

[9]  M. Roback,et al.  Chest radiograph in the evaluation of first time wheezing episodes: Review of current clinical practice and efficacy , 1998, Pediatric emergency care.

[10]  D. Christakis,et al.  Pediatricians' awareness of and attitudes about four clinical practice guidelines. , 1998, Pediatrics.

[11]  C. Byington,et al.  Sepsis evaluations in hospitalized infants with bronchiolitis. , 1998, The Pediatric infectious disease journal.

[12]  S. McMahon,et al.  The Use of Albuterol in Hospitalized Infants With Bronchiolitis , 1998, Pediatrics.

[13]  G. Swingler,et al.  Randomised controlled trial of clinical outcome after chest radiograph in ambulatory acute lower-respiratory infection in children , 1998, The Lancet.

[14]  K. Carriere,et al.  Managing Health Services: How Administrative Data and Population-Based Analyses Can Focus the Agenda , 1998, Health services management research.

[15]  G. Marshall,et al.  Effect of rapid viral diagnosis on the management of children hospitalized with lower respiratory tract infection. , 1997, The Pediatric infectious disease journal.

[16]  E. Wang,et al.  Does ribavirin impact on the hospital course of children with respiratory syncytial virus (RSV) infection? An analysis using the pediatric investigators collaborative network on infections in Canada (PICNIC) RSV database. , 1997, Pediatrics.

[17]  H. Davies,et al.  Reliability of the chest radiograph in the diagnosis of lower respiratory infections in young children. , 1996, The Pediatric infectious disease journal.

[18]  B. Singsen.  Health status (arthritis impact) in children with chronic rheumatic diseases. Current measurement issues and an approach to instrument design. , 1991, Arthritis care and research : the official journal of the Arthritis Health Professions Association.

[19]  R. Holzman,et al.  Screening for respiratory syncytial virus and assignment to a cohort at admission to reduce nosocomial transmission. , 1990, The Journal of pediatrics.

[20]  P. Cartlidge,et al.  Chest physiotherapy in acute bronchiolitis. , 1985, Archives of disease in childhood.

[21]  D. Bergman,et al.  Clinical practice guidelines in pediatric and newborn medicine: implications for their use in practice. , 1997, Pediatrics.