Physician Learning Program, Continuing Medical Education and Professional Development, Cumming School of Medicine, University of Calgary, Calgary, AB.
Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB.
CJEM. 2020 Sep;22(5):678-686. doi: 10.1017/cem.2020.374.
Despite strong evidence recommending supportive care as the mainstay of management for most infants with bronchiolitis, prior studies show that patients still receive low-value care (e.g., respiratory viral testing, salbutamol, chest radiography). Our objective was to decrease low-value care by delivering individual physician reports, in addition to group-facilitated feedback sessions to pediatric emergency physicians.
Our cohort included 3,883 patients ≤ 12 months old who presented to pediatric emergency departments in Calgary, Alberta, with a diagnosis of bronchiolitis from April 1, 2013, to April 30, 2018. Using administrative data, we captured baseline characteristics and therapeutic interventions. Consenting pediatric emergency physicians received two audit and feedback reports, which included their individual data and peer comparators. A multidisciplinary group-facilitated feedback session presented data and identified barriers and enablers of reducing low-value care. The primary outcome was the proportion of patients who received any low-value intervention and was analysed using statistical process control charts.
Seventy-eight percent of emergency physicians consented to receive their audit and feedback reports. Patient characteristics were similar in the baseline and intervention period. Following the baseline physician reports and the group feedback session, low-value care decreased from 42.6% to 27.1% (absolute difference: -15.5%; 95% CI: -19.8% to -11.2%) and 78.9% to 64.4% (absolute difference: -14.5%; 95% CI: -21.9% to -7.2%) in patients who were not admitted and admitted, respectively. Balancing measures, such as intensive care unit admission and emergency department revisit, were unchanged.
The combination of audit and feedback and a group-facilitated feedback session reduced low-value care for patients with bronchiolitis.
尽管有强有力的证据表明支持性护理是大多数毛细支气管炎患儿管理的主要方法，但先前的研究表明，患者仍接受低价值的护理（例如，呼吸道病毒检测、沙丁胺醇、胸部 X 光检查）。我们的目标是通过向儿科急诊医生提供个人医生报告以及小组促进的反馈会议来减少低价值的护理。
我们的队列包括 2013 年 4 月 1 日至 2018 年 4 月 30 日在卡尔加里儿科急诊就诊的 3883 名≤12 个月大的毛细支气管炎患儿。使用行政数据，我们捕获了基线特征和治疗干预措施。同意接受审核和反馈报告的儿科急诊医生收到了两份报告，其中包括他们的个人数据和同行比较器。一个多学科小组促进的反馈会议提供了数据，并确定了减少低价值护理的障碍和促进因素。主要结果是接受任何低价值干预的患者比例，并使用统计过程控制图进行分析。
78%的急诊医生同意接收他们的审核和反馈报告。基线和干预期间患者特征相似。在基线医生报告和小组反馈会议之后，未入院和入院患者的低价值护理分别从 42.6%降至 27.1%（绝对差异：-15.5%；95%CI：-19.8%至-11.2%）和从 78.9%降至 64.4%（绝对差异：-14.5%；95%CI：-21.9%至-7.2%）。平衡措施，如重症监护病房入院和急诊部门复诊，没有变化。
审核和反馈以及小组促进的反馈会议的结合减少了毛细支气管炎患者的低价值护理。
