美国儿科学会毛细支气管炎质量改进项目中的可持续性

Sustainability in the AAP Bronchiolitis Quality Improvement Project.

作者信息

Shadman Kristin A, Ralston Shawn L, Garber Matthew D, Eickhoff Jens, Mussman Grant M, Walley Susan C, Rice-Conboy Elizabeth, Coller Ryan J

机构信息

University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.

Children's Hospital at Dartmouth, Lebanon, New Hampshire, USA.

出版信息

J Hosp Med. 2017 Nov;12(11):905-910. doi: 10.12788/jhm.2830. Epub 2017 Sep 6.

DOI:10.12788/jhm.2830

PMID:29091978

Abstract

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.

摘要

背景与目的

通过美国儿科学会（AAP）的多机构合作项目——毛细支气管炎质量改进项目（BQIP），对AAP毛细支气管炎临床实践指南建议的依从性有了显著提高。我们评估了合作结束后1年内参与机构改进措施的可持续性。

方法

21个多学科的医院团队在基线期和干预期毛细支气管炎季节每月提供关键住院毛细支气管炎指标的数据。9个站点在合作结束后的季节提供数据。纳入的病例包括24个月以下因毛细支气管炎住院且无慢性疾病、早产或重症监护合并症的儿童。使用具有特定站点随机效应的广义线性混合效应模型评估基线期、干预期和可持续性期数据之间的变化。比较了参与和未参与可持续性期的站点之间的医院特征、基线表现和初始改进情况。

结果

共审查了2275例出院病例，包括995例基线期、877例干预期和403例可持续性期病例。干预期实现的所有关键毛细支气管炎质量指标的改进在可持续性期得以维持，间歇性脉搏血氧饱和度测定的医嘱从40.6%（95%置信区间[CI]，22.8 - 61.1）增加到79.2%（95%CI，58.0 - 91.3）。参与和未参与可持续性期的站点具有相似的特征。