P0592 - Impact of Hospital-based Quality Improvement in Bronchiolitis on Community Outpatient Care

Background
Despite extensive literature on inpatient quality improvement (QI) to decrease unnecessary therapy in acute viral bronchiolitis, there is little evidence that inpatient efforts can affect outpatient care.
Objective
We sought to assess whether hospital-led quality improvement initiatives to reduce bronchodilator use in bronchiolitis influenced outpatient utilization.
Methods
We conducted a retrospective chart review assessing outpatient utilization of albuterol in children referred to a free-standing children’s hospital for bronchiolitis from community settings and compared it to inpatient usage during a period of active QI. We defined community settings as private practice, urgent care or emergency departments without pediatric specialization who routinely referred to East Tennessee Children’s Hospital (ETCH). ETCH participated in two consecutive QI collaborative interventions employing a multi-component approach to decreasing routine albuterol use in bronchiolitis. Winter 2014 represented the intervention period for the first QI collaborative and Winter 2016 for the second. The hospital wrote letters to outpatient providers in its referral base explaining the specific goals to decrease the usage of non-evidence-based therapies in bronchiolitis). No other interventions were done in the outpatient setting. The primary outcome was seasonal utilization of albuterol in the outpatient referral sites from January 2012 to December 2018, analyzed using statistical process control. We also compared utilization of albuterol in the referral base to utilization rates in the children’s hospital using a correlation coefficient calculated using seasonal aggregate usage in each setting
Results
Figure 1 demonstrates the rate of albuterol usage in the community referral base during the study period. Special cause was demonstrated and sustained during the intervention period of collaborative 2, with use of albuterol declining from 61.2% (n=1616) to 43.4% (n=1134). Aggregate seasonal usage in the inpatient setting declined from a high of 66.8% (n=413) in the 2012 season to a low of 43.1% (n=350) in the 2017 season and was highly correlated with the observed outpatient decline (R=0.77).
Conclusion
The community referral base of a freestanding children’s hospital demonstrated declining albuterol usage correlating with the hospital’s own declining usage over an extended period of hospital-based QI.