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Sustainability in the AAP Bronchiolitis Quality Improvement Project
Author(s) -
Shadman Kristin A.,
Ralston Shawn L.,
Garber Matthew D.,
Eickhoff Jens,
Mussman Grant M.,
Walley Susan C.,
RiceConboy Elizabeth,
Coller Ryan J.
Publication year - 2017
Publication title -
journal of hospital medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.128
H-Index - 65
eISSN - 1553-5606
pISSN - 1553-5592
DOI - 10.12788/jhm.2830
Subject(s) - bronchiolitis , medicine , sustainability , quality management , guideline , confidence interval , pediatrics , operations management , ecology , management system , pathology , respiratory system , economics , biology
BACKGROUND AND OBJECTIVES 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. METHODS 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. RESULTS 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. DISCUSSION 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.