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(Chest. 2002;121:1789-1797.)
© 2002 American College of Chest Physicians

Impact of a Bronchiolitis Guideline*

A Multisite Demonstration Project

Uma R. Kotagal, MBBS, MSc; James M. Robbins, PhD; Narendra M. Kini, MD, MHA; Pamela J. Schoettker, MS; Harry D. Atherton, BSEE, MS and Mark S. Kirschbaum, RN

* From the Health Policy and Clinical Effectiveness Program (Dr. Kotagal, Ms. Schoettker, and Mr. Atherton), Children’s Hospital Medical Center, Cincinnati, OH; the Center for Applied Research and Evaluation (Dr. Robbins), Arkansas Children’s Hospital, Little Rock, AR; Children’s Hospital of Wisconsin (Dr. Kini), Milwaukee, WI; and the Child Health Corporation of America (Mr. Kirschbaum), Overland Park, KS.

Correspondence to: Uma R. Kotagal, MBBS, MSc, Children’s Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229-3039, e-mail: KOTK9J{at}chmcc.org

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

Design: Before and after study.

Setting: Eleven Child Health Accountability Initiative (CHAI) study hospitals.

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

Intervention: 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.

Measurements and 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.

Key Words: bronchiolitis • guideline • multi-site demonstration




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