Unnecessary care for bronchiolitis decreases with increasing inpatient prevalence of bronchiolitis
To measure the association between inpatient bronchiolitis prevalence (IBP) and the delivery of unnecessary tests and treatments to patients hospitalized with bronchiolitis. A multicenter, retrospective, cohort study was performed using the Pediatric Hospital Information System database. All patient...
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| Veröffentlicht in: | Pediatrics (Evanston) 2011-11, Vol.128 (5), p.e1106-e1112 |
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| creator | Van Cleve, William C Christakis, Dimitri A |
| description | To measure the association between inpatient bronchiolitis prevalence (IBP) and the delivery of unnecessary tests and treatments to patients hospitalized with bronchiolitis.
A multicenter, retrospective, cohort study was performed using the Pediatric Hospital Information System database. All patients 2 months to 2 years of age hospitalized with bronchiolitis during 2004-2008 at participating pediatric hospitals were included. Main outcome measures were the probability of receiving potentially unnecessary care for bronchiolitis, including steroids, intravenously administered antibiotics, chest or neck radiographs, and any laboratory tests during hospitalization.
During winter months, with each 1% absolute increase in IBP, patients were less likely to receive steroids (incidence rate ratio: 0.968 [95% confidence interval: 0.960-0.976]; P < .001), radiographs (incidence rate ratio: 0.988 [95% confidence interval: 0.984-0.992]; P < .001), and laboratory tests (incidence rate ratio: 0.992 [95% confidence interval: 0.988-0.995]; P < .001). During summer months, similar associations were observed for steroids and radiographs. No association between IBP and antibiotic use was observed during either time period.
The frequency with which several types of unnecessary care were delivered to patients with bronchiolitis seemed to decrease with increasing IBP. This finding suggests that an association exists between contextual information and care delivery during the management of acute illness, and it highlights the importance of such information for delivery of high-quality health care. |
| doi_str_mv | 10.1542/peds.2011-0655 |
| format | Article |
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A multicenter, retrospective, cohort study was performed using the Pediatric Hospital Information System database. All patients 2 months to 2 years of age hospitalized with bronchiolitis during 2004-2008 at participating pediatric hospitals were included. Main outcome measures were the probability of receiving potentially unnecessary care for bronchiolitis, including steroids, intravenously administered antibiotics, chest or neck radiographs, and any laboratory tests during hospitalization.
During winter months, with each 1% absolute increase in IBP, patients were less likely to receive steroids (incidence rate ratio: 0.968 [95% confidence interval: 0.960-0.976]; P < .001), radiographs (incidence rate ratio: 0.988 [95% confidence interval: 0.984-0.992]; P < .001), and laboratory tests (incidence rate ratio: 0.992 [95% confidence interval: 0.988-0.995]; P < .001). During summer months, similar associations were observed for steroids and radiographs. No association between IBP and antibiotic use was observed during either time period.
The frequency with which several types of unnecessary care were delivered to patients with bronchiolitis seemed to decrease with increasing IBP. This finding suggests that an association exists between contextual information and care delivery during the management of acute illness, and it highlights the importance of such information for delivery of high-quality health care.</description><identifier>ISSN: 0031-4005</identifier><identifier>EISSN: 1098-4275</identifier><identifier>DOI: 10.1542/peds.2011-0655</identifier><identifier>PMID: 21987704</identifier><identifier>CODEN: PEDIAU</identifier><language>eng</language><publisher>United States: American Academy of Pediatrics</publisher><subject>Antibiotics ; Bronchiolitis, Viral - diagnosis ; Bronchiolitis, Viral - epidemiology ; Bronchiolitis, Viral - therapy ; Child ; Child, Hospitalized - statistics & numerical data ; Child, Preschool ; Cohort Studies ; Confidence Intervals ; Correlation analysis ; Databases, Factual ; Female ; Hospitals, Pediatric ; Humans ; Infant ; Inpatients - statistics & numerical data ; Length of Stay ; Male ; Medical treatment ; Multivariate Analysis ; Odds Ratio ; Patient Readmission - statistics & numerical data ; Pediatrics ; Prevalence ; Quality of Health Care ; Regression Analysis ; Retrospective Studies ; Risk Assessment ; Severity of Illness Index ; Steroids ; Treatment Outcome ; United States - epidemiology ; Unnecessary Procedures - statistics & numerical data</subject><ispartof>Pediatrics (Evanston), 2011-11, Vol.128 (5), p.e1106-e1112</ispartof><rights>Copyright American Academy of Pediatrics Nov 2011</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c321t-2cf803b2aeabb7bbe01d881300eee38f3285d4f0f26491bdd4d7b601f790b9463</citedby><cites>FETCH-LOGICAL-c321t-2cf803b2aeabb7bbe01d881300eee38f3285d4f0f26491bdd4d7b601f790b9463</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,777,781,27905,27906</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/21987704$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Van Cleve, William C</creatorcontrib><creatorcontrib>Christakis, Dimitri A</creatorcontrib><title>Unnecessary care for bronchiolitis decreases with increasing inpatient prevalence of bronchiolitis</title><title>Pediatrics (Evanston)</title><addtitle>Pediatrics</addtitle><description>To measure the association between inpatient bronchiolitis prevalence (IBP) and the delivery of unnecessary tests and treatments to patients hospitalized with bronchiolitis.
A multicenter, retrospective, cohort study was performed using the Pediatric Hospital Information System database. All patients 2 months to 2 years of age hospitalized with bronchiolitis during 2004-2008 at participating pediatric hospitals were included. Main outcome measures were the probability of receiving potentially unnecessary care for bronchiolitis, including steroids, intravenously administered antibiotics, chest or neck radiographs, and any laboratory tests during hospitalization.
During winter months, with each 1% absolute increase in IBP, patients were less likely to receive steroids (incidence rate ratio: 0.968 [95% confidence interval: 0.960-0.976]; P < .001), radiographs (incidence rate ratio: 0.988 [95% confidence interval: 0.984-0.992]; P < .001), and laboratory tests (incidence rate ratio: 0.992 [95% confidence interval: 0.988-0.995]; P < .001). During summer months, similar associations were observed for steroids and radiographs. No association between IBP and antibiotic use was observed during either time period.
The frequency with which several types of unnecessary care were delivered to patients with bronchiolitis seemed to decrease with increasing IBP. This finding suggests that an association exists between contextual information and care delivery during the management of acute illness, and it highlights the importance of such information for delivery of high-quality health care.</description><subject>Antibiotics</subject><subject>Bronchiolitis, Viral - diagnosis</subject><subject>Bronchiolitis, Viral - epidemiology</subject><subject>Bronchiolitis, Viral - therapy</subject><subject>Child</subject><subject>Child, Hospitalized - statistics & numerical data</subject><subject>Child, Preschool</subject><subject>Cohort Studies</subject><subject>Confidence Intervals</subject><subject>Correlation analysis</subject><subject>Databases, Factual</subject><subject>Female</subject><subject>Hospitals, Pediatric</subject><subject>Humans</subject><subject>Infant</subject><subject>Inpatients - statistics & numerical data</subject><subject>Length of Stay</subject><subject>Male</subject><subject>Medical treatment</subject><subject>Multivariate Analysis</subject><subject>Odds Ratio</subject><subject>Patient Readmission - statistics & numerical data</subject><subject>Pediatrics</subject><subject>Prevalence</subject><subject>Quality of Health Care</subject><subject>Regression Analysis</subject><subject>Retrospective Studies</subject><subject>Risk Assessment</subject><subject>Severity of Illness Index</subject><subject>Steroids</subject><subject>Treatment Outcome</subject><subject>United States - epidemiology</subject><subject>Unnecessary Procedures - statistics & numerical data</subject><issn>0031-4005</issn><issn>1098-4275</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2011</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdkD1PwzAQhi0EoqWwMqKIhSnl7DhxPCLEl1SJhc6R7Zypq9QJdgLi35PSggTT3UnP--r0EHJOYU5zzq47rOOcAaUpFHl-QKYUZJlyJvJDMgXIaMoB8gk5iXENADwX7JhMGJWlEMCnRC-9R4MxqvCZGBUwsW1IdGi9Wbm2cb2LSY0moIoYkw_XrxLnv0_nX8e1U71D3yddwHfVoDeYtPZv_pQcWdVEPNvPGVne373cPqaL54en25tFajJG-5QZW0KmmUKltdAagdZlSTMARMxKm7Eyr7kFywouqa5rXgtdALVCgpa8yGbkatfbhfZtwNhXGxcNNo3y2A6xksCgFDmXI3n5j1y3Q_DjcyPEJWdFwUZovoNMaGMMaKsuuM2oqaJQbd1XW_fV1n21dT8GLvatg95g_Yv_yM6-AJi5gbE</recordid><startdate>20111101</startdate><enddate>20111101</enddate><creator>Van Cleve, William C</creator><creator>Christakis, Dimitri A</creator><general>American Academy of Pediatrics</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7TS</scope><scope>7U9</scope><scope>H94</scope><scope>K9.</scope><scope>M7N</scope><scope>NAPCQ</scope><scope>U9A</scope><scope>7X8</scope></search><sort><creationdate>20111101</creationdate><title>Unnecessary care for bronchiolitis decreases with increasing inpatient prevalence of bronchiolitis</title><author>Van Cleve, William C ; Christakis, Dimitri A</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c321t-2cf803b2aeabb7bbe01d881300eee38f3285d4f0f26491bdd4d7b601f790b9463</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2011</creationdate><topic>Antibiotics</topic><topic>Bronchiolitis, Viral - diagnosis</topic><topic>Bronchiolitis, Viral - epidemiology</topic><topic>Bronchiolitis, Viral - therapy</topic><topic>Child</topic><topic>Child, Hospitalized - statistics & numerical data</topic><topic>Child, Preschool</topic><topic>Cohort Studies</topic><topic>Confidence Intervals</topic><topic>Correlation analysis</topic><topic>Databases, Factual</topic><topic>Female</topic><topic>Hospitals, Pediatric</topic><topic>Humans</topic><topic>Infant</topic><topic>Inpatients - statistics & numerical data</topic><topic>Length of Stay</topic><topic>Male</topic><topic>Medical treatment</topic><topic>Multivariate Analysis</topic><topic>Odds Ratio</topic><topic>Patient Readmission - statistics & numerical data</topic><topic>Pediatrics</topic><topic>Prevalence</topic><topic>Quality of Health Care</topic><topic>Regression Analysis</topic><topic>Retrospective Studies</topic><topic>Risk Assessment</topic><topic>Severity of Illness Index</topic><topic>Steroids</topic><topic>Treatment Outcome</topic><topic>United States - epidemiology</topic><topic>Unnecessary Procedures - statistics & numerical data</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Van Cleve, William C</creatorcontrib><creatorcontrib>Christakis, Dimitri A</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Physical Education Index</collection><collection>Virology and AIDS Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>Pediatrics (Evanston)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Van Cleve, William C</au><au>Christakis, Dimitri A</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Unnecessary care for bronchiolitis decreases with increasing inpatient prevalence of bronchiolitis</atitle><jtitle>Pediatrics (Evanston)</jtitle><addtitle>Pediatrics</addtitle><date>2011-11-01</date><risdate>2011</risdate><volume>128</volume><issue>5</issue><spage>e1106</spage><epage>e1112</epage><pages>e1106-e1112</pages><issn>0031-4005</issn><eissn>1098-4275</eissn><coden>PEDIAU</coden><abstract>To measure the association between inpatient bronchiolitis prevalence (IBP) and the delivery of unnecessary tests and treatments to patients hospitalized with bronchiolitis.
A multicenter, retrospective, cohort study was performed using the Pediatric Hospital Information System database. All patients 2 months to 2 years of age hospitalized with bronchiolitis during 2004-2008 at participating pediatric hospitals were included. Main outcome measures were the probability of receiving potentially unnecessary care for bronchiolitis, including steroids, intravenously administered antibiotics, chest or neck radiographs, and any laboratory tests during hospitalization.
During winter months, with each 1% absolute increase in IBP, patients were less likely to receive steroids (incidence rate ratio: 0.968 [95% confidence interval: 0.960-0.976]; P < .001), radiographs (incidence rate ratio: 0.988 [95% confidence interval: 0.984-0.992]; P < .001), and laboratory tests (incidence rate ratio: 0.992 [95% confidence interval: 0.988-0.995]; P < .001). During summer months, similar associations were observed for steroids and radiographs. No association between IBP and antibiotic use was observed during either time period.
The frequency with which several types of unnecessary care were delivered to patients with bronchiolitis seemed to decrease with increasing IBP. This finding suggests that an association exists between contextual information and care delivery during the management of acute illness, and it highlights the importance of such information for delivery of high-quality health care.</abstract><cop>United States</cop><pub>American Academy of Pediatrics</pub><pmid>21987704</pmid><doi>10.1542/peds.2011-0655</doi></addata></record> |
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| subjects | Antibiotics Bronchiolitis, Viral - diagnosis Bronchiolitis, Viral - epidemiology Bronchiolitis, Viral - therapy Child Child, Hospitalized - statistics & numerical data Child, Preschool Cohort Studies Confidence Intervals Correlation analysis Databases, Factual Female Hospitals, Pediatric Humans Infant Inpatients - statistics & numerical data Length of Stay Male Medical treatment Multivariate Analysis Odds Ratio Patient Readmission - statistics & numerical data Pediatrics Prevalence Quality of Health Care Regression Analysis Retrospective Studies Risk Assessment Severity of Illness Index Steroids Treatment Outcome United States - epidemiology Unnecessary Procedures - statistics & numerical data |
| title | Unnecessary care for bronchiolitis decreases with increasing inpatient prevalence of bronchiolitis |
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