Aziz Sara M, Bonsmith Kathleen, Gonzales Ralph, Auerbach Andrew, Douglas Angela, Anderson Madison, Thompson Sara, Edwards Yeelen, Kaiser Sunitha V
Department of Pediatrics, University of California, San Francisco, San Francisco, California.
Current affiliation: Department of Pediatric Hospital Medicine, Kaiser Permanente, Santa Clara, California.
Hosp Pediatr. 2025 Jun 1;15(6):457-465. doi: 10.1542/hpeds.2024-008120.
Clinical pathways can improve care and outcomes for children with respiratory illnesses. The Simultaneously Implementing Pathways for Improving Asthma, Pneumonia, and Bronchiolitis Care for Hospitalized Children (SIP) trial is a multicenter, randomized trial of a high-efficiency pathway intervention in general and community hospitals. Our objective was to describe implementation fidelity, strategy use, time costs, barriers, and facilitators.
We conducted a mixed-methods study. Hospitals received clinical pathways (intervention) and used 5 implementation strategies: quality improvement (QI) mentor meetings, education, iterative changes, audit and feedback, and clinical decision support via electronic order sets. Data were collected through monthly surveys (11 months) of site leaders and recordings of mentor meetings. Quantitative data were analyzed using descriptive statistics, and qualitative data were analyzed using thematic content analysis.
Eighteen site leaders (from 18 hospitals) and 8 QI mentors participated. Monthly survey completion rates were 72% to 100%. Pathway implementation fidelity was high (94%). Implementation strategies with the highest use were QI mentor meetings, iterative changes, and electronic order sets. Audit and feedback had the lowest use, driven by information technology challenges and delays in data collection. Implementation time costs were approximately 14 hours per month, and data collection had the highest time cost. Implementation barriers included time limitations and stakeholder resistance to change. Facilitators included SIP study resources, engagement of multidisciplinary staff, and alignment with institutional goals.
Our multicenter study provides detailed guidance on implementation fidelity, strategy use, time costs, barriers, and facilitators for general and community hospitals implementing high-efficiency pediatric pathway interventions.
临床路径可改善患有呼吸道疾病儿童的护理及治疗效果。“同时实施改善住院儿童哮喘、肺炎和支气管炎护理路径”（SIP）试验是一项在综合医院和社区医院开展的关于高效路径干预的多中心随机试验。我们的目的是描述实施的保真度、策略使用情况、时间成本、障碍和促进因素。
我们进行了一项混合方法研究。医院接受了临床路径（干预措施），并采用了5种实施策略：质量改进（QI）导师会议、教育、迭代变更、审核与反馈，以及通过电子医嘱集提供临床决策支持。通过对现场负责人的月度调查（共11个月）以及导师会议记录收集数据。定量数据采用描述性统计进行分析，定性数据采用主题内容分析进行分析。
18位现场负责人（来自18家医院）和8名QI导师参与了研究。月度调查完成率为72%至100%。路径实施保真度较高（94%）。使用频率最高的实施策略是QI导师会议、迭代变更和电子医嘱集。由于信息技术方面的挑战和数据收集延迟，审核与反馈的使用频率最低。实施的时间成本约为每月14小时，其中数据收集的时间成本最高。实施障碍包括时间限制和利益相关者对变革的抵触。促进因素包括SIP研究资源、多学科工作人员的参与以及与机构目标的一致性。
我们的多中心研究为综合医院和社区医院实施高效儿科路径干预的实施保真度、策略使用情况、时间成本、障碍和促进因素提供了详细指导。
