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Bronchiolitis guidelines decreased use of diagnostic, therapeutic resources
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There have been significant reductions in the use of diagnostic and therapeutic resources since publication of the 2006 AAP bronchiolitis guidelines, according to recent study findings.
“In an era of value-driven care, where we strive to achieve higher-quality outcomes per dollar spent on health care, reducing unnecessary utilization is a priority,” Kavita Parikh, MD, of the division of hospitalist medicine at the Children’s National Medical Center in Washington, D.C., told Infectious Diseases in Children. “Bronchiolitis is a common pediatric diagnosis, in which supportive care is the mainstay of treatment. I hope that this study not only demonstrates a positive impact of evidence-based guidelines, but also highlights certain management questions for individual physicians. For example, does my patient with bronchiolitis truly need a chest x-ray or blood work? Patients who do not improve as expected may warrant additional tests; however, a majority of patients may not benefit from additional testing as it will not alter management.”
Kavita Parikh
Parikh and colleagues evaluated 130,262 children with bronchiolitis aged 1 to 24 months (median age, 4 months) from Nov. 1, 2004, to March 31, 2012, to determine the effect of the 2006 guidelines on treatment of hospitalized children. Fifty-eight percent of the patients were male and 59% were on public insurance.
A segmented regression analysis was done to compare rates of resource utilization before and after the publication of the 2006 AAP guidelines. This analysis demonstrated differences in rates of change before and after guidelines with significant improvement for chest radiography, steroids, and bronchodilators (P<.001), and a trend of improvement for complete blood counts (P=.0061). There was no improvement noted for antibiotic use or RSV testing.
“Overall, evidence-based guidelines, such as the AAP bronchiolitis guidelines, are an important tool to standardize care for children and reduce unnecessary utilization,” Parikh said. “However, establishment of guidelines is only a first step in reducing variation and improving care. Much work remains to effectively disseminate and implement the evidence-based recommendations from these guidelines, and implementation strategies will vary by practice type, location, or region.” — Amber Cox
Disclosure: The study was funded in part by the Young Investigator Award through the Academic Pediatric Association. The study researchers report no relevant financial disclosures.
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