Effectiveness of Targeted Interventions on Treatment of Infants With Bronchiolitis: A Randomized Clinical Trial

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dc.citation.issue8
dc.citation.volume175
dc.contributor.authorHaskell L
dc.contributor.authorTavender EJ
dc.contributor.authorWilson CL
dc.contributor.authorO'Brien S
dc.contributor.authorBabl FE
dc.contributor.authorBorland ML
dc.contributor.authorCotterell E
dc.contributor.authorSchembri R
dc.contributor.authorOrsini F
dc.contributor.authorSheridan N
dc.contributor.authorJohnson DW
dc.contributor.authorOakley E
dc.contributor.authorDalziel SR
dc.contributor.authorPREDICT Network
dc.date.accessioned2023-06-21T03:17:29Z
dc.date.available2021-08
dc.date.available2023-06-21T03:17:29Z
dc.date.issued1/08/2021
dc.description© 2021 Haskell L et al.
dc.description.abstractIMPORTANCE: In developed countries, bronchiolitis is the most common reason for infants to be admitted to the hospital, and all international bronchiolitis guidelines recommend supportive care; however, significant variation in practice continues with infants receiving non-evidence-based therapies. Deimplementation research aims to reduce the use of low-value care, and advancing science in this area is critical to delivering evidence-based care. OBJECTIVE: To determine the effectiveness of targeted interventions vs passive dissemination of an evidence-based bronchiolitis guideline in improving treatment of infants with bronchiolitis. DESIGN, SETTING, AND PARTICIPANTS: This international, multicenter cluster randomized clinical trial included 26 hospitals (clusters) in Australia and New Zealand providing tertiary or secondary pediatric care (13 randomized to intervention, 13 to control) during the 2017 bronchiolitis season. Data were collected on 8003 infants for the 3 bronchiolitis seasons (2014-2016) before the implementation period and 3727 infants for the implementation period (2017 bronchiolitis season, May 1-November 30). Data were analyzed from November 16, 2018, to December 9, 2020. INTERVENTIONS: Interventions were developed using theories of behavior change to target key factors that influence bronchiolitis management. These interventions included site-based clinical leads, stakeholder meetings, a train-the-trainer workshop, targeted educational delivery, other educational and promotional materials, and audit and feedback. MAIN OUTCOMES AND MEASURES: The primary outcome was compliance during the first 24 hours of care with no use of chest radiography, albuterol, glucocorticoids, antibiotics, and epinephrine, measured retrospectively from medical records of randomly selected infants with bronchiolitis who presented to the hospital. There were no patient-level exclusions. RESULTS: A total of 26 hospitals were randomized without dropouts. Analysis was by intention to treat. Baseline data collected on 8003 infants for 3 bronchiolitis seasons (2014-2016) before the implementation period were similar between intervention and control hospitals. Implementation period data were collected on 3727 infants, including 2328 boys (62%) and 1399 girls (38%), with a mean (SD) age of 6.0 (3.2) months. A total of 459 (12%) were Māori (New Zealand), and 295 (8%) were Aboriginal/Torres Strait Islander (Australia). Compliance with recommendations was 85.1% (95% CI, 82.6%-89.7%) in intervention hospitals vs 73.0% (95% CI, 65.3%-78.8%) in control hospitals (adjusted risk difference, 14.1%; 95% CI, 6.5%-21.7%; P < .001). CONCLUSIONS AND RELEVANCE: Targeted interventions led to improved treatment of infants with bronchiolitis. This study has important implications for bronchiolitis management and the development of effective interventions to deimplement low-value care. TRIAL REGISTRATION: Australian and New Zealand Clinical Trials Registry: ACTRN12616001567415.
dc.description.publication-statusPublished
dc.format.extent797 - 806
dc.identifierhttp://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000640665900003&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=c5bb3b2499afac691c2e3c1a83ef6fef
dc.identifier.citationJAMA PEDIATRICS, 2021, 175 (8), pp. 797 - 806
dc.identifier.doi10.1001/jamapediatrics.2021.0295
dc.identifier.eissn2168-6211
dc.identifier.elements-id444399
dc.identifier.harvestedMassey_Dark
dc.identifier.issn2168-6203
dc.identifier.urihttps://hdl.handle.net/10179/18326
dc.publisherAmerican Medical Association
dc.relation.isPartOfJAMA PEDIATRICS
dc.subject.anzsrc1114 Paediatrics and Reproductive Medicine
dc.titleEffectiveness of Targeted Interventions on Treatment of Infants With Bronchiolitis: A Randomized Clinical Trial
dc.typeJournal article
pubs.notesNot known
pubs.organisational-group/Massey University
pubs.organisational-group/Massey University/College of Health
pubs.organisational-group/Massey University/College of Health/PVC's Office - College of Health
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