Mussman Grant M, Sahay Rashmi D, Destino Lauren, Lossius Michele, Shadman Kristin A, Walley Susan C
Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio;
Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
Hosp Pediatr. 2017 May;7(5):279-286. doi: 10.1542/hpeds.2016-0090.
Adoption of clinical respiratory scoring as a quality improvement (QI) tool in bronchiolitis has been temporally associated with decreased bronchodilator usage. We sought to determine whether documented use of a clinical respiratory score at the patient level was associated with a decrease in either the physician prescription of any dose of bronchodilator or the number of doses, if prescribed, in a multisite QI collaborative.
We performed a secondary analysis of data from a QI collaborative involving 22 hospitals. The project enrolled patients aged 1 month to 2 years with a primary diagnosis of acute viral bronchiolitis and excluded those with prematurity, other significant comorbid diseases, and those needing intensive care. We assessed for an association between documentation of any respiratory score use during an episode of care, as well as the method in which scores were used, and physician prescribing of any bronchodilator and number of doses. Covariates considered were phase of the collaborative, hospital length of stay, steroid use, and presence of household smokers.
A total of 1876 subjects were included. There was no association between documentation of a respiratory score and the likelihood of physician prescribing of any bronchodilator. Score use was associated with fewer doses of bronchodilators if one was prescribed ( = .05), but this association disappeared with multivariable analysis ( = .73).
We found no clear association between clinical respiratory score use and physician prescribing of bronchodilators in a multicenter QI collaborative.
在毛细支气管炎中采用临床呼吸评分作为质量改进（QI）工具，在时间上与支气管扩张剂使用减少相关。我们试图确定在多中心QI协作中，患者层面记录的临床呼吸评分使用情况是否与任何剂量支气管扩张剂的医生处方减少或（若已处方）剂量数量减少相关。
我们对来自一个涉及22家医院的QI协作的数据进行了二次分析。该项目纳入了1个月至2岁、初步诊断为急性病毒性毛细支气管炎的患者，排除了早产、其他重大合并疾病以及需要重症监护的患者。我们评估了在一次护理过程中任何呼吸评分使用的记录情况、评分的使用方法与医生开具任何支气管扩张剂及剂量数量之间的关联。考虑的协变量包括协作阶段、住院时间、类固醇使用情况以及家庭吸烟者的存在情况。
共纳入1876名受试者。呼吸评分的记录与医生开具任何支气管扩张剂的可能性之间无关联。如果开具了支气管扩张剂，评分的使用与较少的支气管扩张剂剂量相关（P = 0.05），但在多变量分析中这种关联消失了（P = 0.73）。
在多中心QI协作中，我们未发现临床呼吸评分的使用与医生开具支气管扩张剂之间存在明确关联。
