Simultaneously Implementing Pathways for Improving Asthma, Pneumonia, and Bronchiolitis Care for Hospitalized Children
- Conditions
- PneumoniaAsthmaBronchiolitis
- Interventions
- Behavioral: Multi-condition Pathway Intervention
- Registration Number
- NCT05206695
- Lead Sponsor
- University of California, San Francisco
- Brief Summary
This study's objective is to identify and test pragmatic and sustainable strategies for implementing a multi-condition clinical pathway intervention for children hospitalized with asthma, pneumonia, or bronchiolitis in community hospitals. The hypothesis is that the multi-condition pathway intervention will be associated with significantly greater increases in clinicians' adoption of evidence-based practices compared to control. The study is a pragmatic, cluster-randomized trial in US community hospitals. The primary outcome will be adoption of evidence-based practices over a sustained period of 2 years. Secondary outcomes include length of hospital stay, intensive care unit transfer, and hospital readmission/emergency department revisit.
- Detailed Description
Asthma, pneumonia, and bronchiolitis are the top causes of childhood hospitalization in the US, leading to approximately 350,000 hospitalizations and $2 billion in costs annually. Poor guideline adoption by clinicians contributes to poor health outcomes for children hospitalized with these respiratory illnesses, including longer recovery time/hospital stay, higher rates of transfer to intensive care units, and increased risk of hospital readmission.
Pathways can improve clinicians' adoption of evidence-based practices/guidelines in both children's and community hospital settings. Pathways are simple, visual diagrams that guide clinicians step-by-step through the evidence-based care of a specific medical condition (accessed via paper or electronically). Most hospitals implement pathways for a single medical condition at a time (e.g., asthma). But Seattle Children's Hospital developed an intervention for simultaneously implementing pathways for multiple conditions. This intervention led to sustained guideline adoption, decreased length of stay, and decreased costs; and, these effects were comparable to those shown with single-condition pathway implementation. This multi-condition pathway intervention has not yet been studied in community hospitals, which face unique implementation barriers.
The study's objective is to identify and test pragmatic and sustainable strategies for implementing a multi-condition pathway intervention for children hospitalized with asthma, pneumonia, or bronchiolitis in community hospitals. The study is a pragmatic, cluster-randomized trial in US community hospitals. The pathway intervention will be implemented using the key implementation strategies defined for this intervention (audit and feedback, electronic health record integration, plan-do-study-act cycles). The primary outcome will be adoption of evidence-based practices over a sustained period of 2 years. Secondary outcomes include length of hospital stay, intensive care unit transfer, and hospital readmission/emergency department revisit.
Recruitment & Eligibility
- Status
- ACTIVE_NOT_RECRUITING
- Sex
- All
- Target Recruitment
- 16800
- Primary diagnosis of asthma AND age >2 to <18 years-old at time of admission to the hospital OR
- Primary diagnosis of pneumonia AND age >2 months and <18 years at time of admission to the hospital OR
- Primary diagnosis of bronchiolitis AND age <2 years at time of admission to the hospital
- Diagnosis of SARS-CoV-2
- Transfer in from another inpatient facility
- Pre-existing chronic illnesses (e.g., lung disease, cardiovascular disease, neurologic disorders)
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Multi-condition Pathway Intervention Multi-condition Pathway Intervention The multi-condition pathway intervention consists of pathways clinicians select from to guide the care of children with asthma, pneumonia, or bronchiolitis. Key implementation strategies include audit and feedback, plan-do-study-act cycles, and electronic order sets.
- Primary Outcome Measures
Name Time Method Pneumonia Evidence Based Practice 1 During a hospitalization, approximately 2 days Administration of narrow spectrum antibiotic
Pneumonia Evidence Based Practice 2 During a hospitalization, approximately 2 days No prescription of macrolide antibiotics
Asthma Evidence Based Practice 3 During a hospitalization, approximately 2 days Use of an asthma pathway/bronchodilator weaning protocol
Bronchiolitis Evidence Based Practice 2 During a hospitalization, approximately 2 days No chest radiographs
Asthma Evidence Based Practice 1 During a hospitalization, approximately 2 days Prescription of inhaled corticosteroids for children greater than or equal to 5 years-old
Asthma Evidence Based Practice 2 During a hospitalization, approximately 2 days Use of metered-dose inhalers
Bronchiolitis Evidence Based Practice 1 During a hospitalization, approximately 2 days No administration of bronchodilators
- Secondary Outcome Measures
Name Time Method Length of Hospital Stay During a hospitalization, approximately 2 days Length Hospital Stay
30-day Hospital Readmission or Emergency Department Revisit 30 days after hospital discharge Event of a patient being readmitted to hospital or having an emergency department visit within 30 days of hospital discharge
Transfer to Intensive Care During a hospitalization, approximately 2 days The event of patient being transferred to an ICU
Trial Locations
- Locations (1)
University of California, San Francisco
🇺🇸San Francisco, California, United States