Improving Management of Bronchiolitis Across a Primary Care Network.

BACKGROUND AND

OBJECTIVE

Bronchiolitis is the most common respiratory illness in children younger than 2 years. Although pharmacotherapy has not been shown to alter mild disease course, overuse continues in the primary care setting. We sought to improve the management of bronchiolitis in a large primary care network by reducing bronchodilator use from 24% to 15% while maintaining steroid use at 7% within 12 months.

METHODS

Our primary care network is composed of 39 clinics in rural and urban settings across 3 states. Interventions through 4 Plan-Do-Study-Act cycles included (1) stakeholder engagement, education, and implementation of a clinical algorithm with supportive electronic health record enhancements, (2) data sharing and feedback, (3) refinement of documentation, and (4) incentives and automated individual feedback. The outcome measure was bronchodilator and steroid use. The process measure was respiratory score (RS) documentation. The balancing measure was the percentage of return visits within 7 days of the initial primary care visit.

RESULTS

We included 3158 patients in the baseline and 5465 in the postintervention period. Albuterol use decreased from 24% to 11%. Steroid use decreased from 7% to 1%. The RS documentation did not improve and was not continued. Return visits decreased from 10% to 8%.

CONCLUSION

Data transparency, provider scorecards, and standardization of care effectively promoted compliance and improvement through a learning health system within a large primary care network. Primary care's involvement in this quality initiative to improve children's outcomes was key to its success.