Sustainability in the AAP Bronchiolitis Quality Improvement Project

• Published in: Journal of hospital medicine 2017-11, Vol.12 (11), p.905-910
• Main Authors: Shadman, Kristin A, Ralston, Shawn L, Garber, Matthew D, Eickhoff, Jens, Mussman, Grant M, Walley, Susan C, Rice-Conboy, Elizabeth, Coller, Ryan J
• Format: Article
• Language: English
• Subjects: Bronchiolitis - drug therapy; Evidence-Based Practice; Guideline Adherence - standards; Hospitalization; Humans; Infant; Inpatients; Oximetry; Quality Improvement
• ISSN: 1553-5606; 1553-5606
• DOI: 10.12788/jhm2830

Adherence to American Academy of Pediatrics (AAP) bronchiolitis clinical practice guideline recommendations improved significantly through the AAP's multiinstitutional collaborative, the Bronchiolitis Quality Improvement Project (BQIP). We assessed sustainability of improvements at participating institutions for 1 year following completion of the collaborative. Twenty-one multidisciplinary hospital-based teams provided monthly data for key inpatient bronchiolitis measures during baseline and intervention bronchiolitis seasons. Nine sites provided data in the season following completion of the collaborative. Encounters included children younger than 24 months who were hospitalized for bronchiolitis without comorbid chronic illness, prematurity, or intensive care. Changes between baseline-, intervention-, and sustainability-season data were assessed using generalized linear mixed-effects models with site-specific random effects. Differences between hospital characteristics, baseline performance, and initial improvement between sites that did and did not participate in the sustainability season were compared. A total of 2275 discharges were reviewed, comprising 995 baseline, 877 intervention, and 403 sustainability- season encounters. Improvements in all key bronchiolitis quality measures achieved during the intervention season were maintained during the sustainability season, and orders for intermittent pulse oximetry increased from 40.6% (95% confidence interval [CI], 22.8-61.1) to 79.2% (95% CI, 58.0- 91.3). Sites that did and did not participate in the sustainability season had similar characteristics. BQIP participating sites maintained improvements in key bronchiolitis quality measures for 1 year following the project's completion. This approach, which provided an evidence-based best-practice toolkit while building the quality-improvement capacity of local interdisciplinary teams, may support performance gains that persist beyond the active phase of the collaborative.