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Hospitalists better adhered to bronchiolitis guidelines than nonhospitalists
McCulloh RJ. Hospital Pediatr. 2012;doi:10.1542/hpeds.2011-0002-2.
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Hospitalists adhere better to portions of the American Academy of Pediatrics’ bronchiolitis guidelines and provide higher quality care, according to study results published online in Hospital Pediatrics.
To assess quality of care between hospitalists and nonhospitalists, researchers initiated a retrospective chart review of children admitted for bronchiolitis to two academic centers — the Hasbro Children’s Hospital of Rhode Island Hospital and University of Missouri Women and Children’s Hospital. As a common cause of pediatric hospital admission, bronchiolitis cases were used to identify quality indicators for the evaluation and treatment of hospitalized children and examine differences in guideline adherence rates between hospitalists and nonhospitalists.
From 2007 to 2008, researchers screened charts with primary discharge diagnoses, including non-respiratory syncytial virus bronchiolitis, apnea, respiratory syncytial virus bronchiolitis, acute upper respiratory infection, asthma/unspecified, and unspecified viral illness. Exclusion criteria for this cohort consisted of:
- Patients older than 2 years.
- Patients first admitted to the ICU.
- Patients without either primary or secondary discharge diagnosis of bronchiolitis.
The researchers accepted 713 charts for examination and found that in patients without objective response to bronchodilator therapy, physician discontinuation rates of racemic epinephrine were similar between hospitalists (92.9%) and nonhospitalists (91.4%), whereas discontinued albuterol treatments differed slightly between physicians (84% of hospitalists, 80.5% of nonhospitalists; P=.57).
However, researchers found that hospitalists and nonhospitalists differed significantly in their discontinuation of unnecessary systemic corticosteroid therapy (75% of hospitalists, 42.4% of nonhospitalists; P=.001), as well as antibiotic therapy in patients not diagnosed with bacterial infection (71% of hospitalists, 48.6% of nonhospitalists; P=.007).
“Quality indicators used in this study can distinguish physician performance in the inpatient management of bronchiolitis and may prove useful in future efforts to reduce overutilization of unnecessary medical interventions for bronchiolitis management,” the researchers said.
Disclosure: The researchers report no relevant financial disclosures.