Edwards Yeelen, Yang Nancy, Auerbach Andrew D, Gonzales Ralph, McCulloch Charles E, Howell Eric E, Goldstein Jenna, Thompson Sara, Kaiser Sunitha V
Department of Pediatrics, University of California, San Francisco, California, USA.
Department of Medicine, University of California, San Francisco, California, USA.
J Hosp Med. 2024 Dec;19(12):1203-1210. doi: 10.1002/jhm.13482. Epub 2024 Aug 14.
Asthma, pneumonia, and bronchiolitis are the top causes of childhood hospitalization in the United States, leading to over 350,000 hospitalizations and ≈$2 billion in costs annually. The majority of these hospitalizations occur in general/community hospitals. Poor guideline adoption by clinicians contributes to poor health outcomes for children hospitalized with these illnesses, including longer recovery time/hospital stay, higher rates of intensive care unit transfer, and increased risk of hospital readmission. A prior single-center study at a children's hospital tested a multicondition clinical pathway intervention (simultaneous implementation of multiple pathways for multiple pediatric conditions) and demonstrated improved clinician guideline adherence and patient health outcomes. This intervention has not yet been studied in community hospitals, which face unique implementation barriers.
To study the implementation and effectiveness of a multicondition pathway intervention for children hospitalized with asthma, pneumonia, or bronchiolitis in community hospitals.
We will conduct a pragmatic, hybrid effectiveness-implementation, cluster-randomized trial in community hospitals around the United States (1:1 randomization to intervention vs. wait-list control). Our primary outcome will be the adoption of two to three evidence-based practices for each condition over a sustained period of 2 years. Secondary outcomes include hospital length of stay, ICU transfer, and readmission.
This hybrid trial will lead to a comprehensive understanding of how to pragmatically and sustainably implement a multicondition pathway intervention in community hospitals and an assessment of its effects. Enrollment began in July 2022 and is projected to be completed in September 2024. Primary analysis completion is anticipated in March 2025, with reporting of results following.
在美国，哮喘、肺炎和支气管炎是儿童住院的主要原因，每年导致超过35万例住院病例，花费约20亿美元。这些住院病例大多发生在综合/社区医院。临床医生对指南的依从性差导致患有这些疾病的住院儿童健康结局不佳，包括恢复时间/住院时间延长、重症监护病房转诊率更高以及再次入院风险增加。一家儿童医院之前的单中心研究测试了一种多病症临床路径干预措施（同时为多种儿科病症实施多种路径），并证明临床医生对指南的依从性和患者健康结局有所改善。这种干预措施尚未在面临独特实施障碍的社区医院中进行研究。
研究社区医院中针对因哮喘、肺炎或支气管炎住院儿童的多病症路径干预措施的实施情况和效果。
我们将在美国各地的社区医院进行一项务实的、混合效果-实施的整群随机试验（1:1随机分配至干预组与等待名单对照组）。我们的主要结局将是在2年的持续时间内针对每种病症采用两到三种基于证据的做法。次要结局包括住院时间、重症监护病房转诊和再次入院情况。
这项混合试验将全面了解如何在社区医院务实且可持续地实施多病症路径干预措施，并评估其效果。入组于2022年7月开始，预计于2024年9月完成。预计2025年3月完成初步分析，并随后报告结果。
