High adherence to bronchiolitis clinical pathway recommendations in health care settings is associated with shorter length of stay (LOS) and lower health care costs, according to Mersine A. Bryan, MD, of the University of Washington, Seattle and her associates.
In a retrospective cohort study, researchers looked at 267 patients less than 24 months old diagnosed with bronchiolitis from December 2009 to July 2012. Levels of adherence were then categorized into low, middle, and high tertiles. Results show that adherence was highest for the inpatient quality indicators (mean score, 95) and lowest for the emergency department (ED) quality indicators (mean score, 79). The mean ED LOS was significantly shorter for cases with ED adherence scores in the highest versus the lowest tertile (90 vs. 140 minutes; P less than .05). There were no significant differences in mean inpatient LOS by inpatient adherence score tertiles. “However, the mean inpatient LOS was approximately 17 hours shorter for cases with combined ED/inpatient adherence scores in the highest, compared with the lowest tertile,” they said.
The mean ED costs for cases with ED adherence scores in the highest tertile were significantly lower than cases with scores in the lowest tertile (–$84; P less than .05). It is noted there were no significant differences in mean total costs by inpatient adherence score tertile, but “for cases where the combined ED/inpatient adherence scores were in the highest tertile, the mean total costs were significantly lower than for cases with combined adherence scores in the lowest tertile, the researchers noted. Also, cases with ED adherence scores in the highest tertile had lower odds of inpatient admission, compared with those with scores in the lowest tertile (odds ratio, 0.38). There were no significant differences in the odds of return ED visits or readmissions by adherence score tertile.
“Our study demonstrates that high adherence to evidence-based recommendations within a clinical pathway across the entire continuum of care, from the ED to the inpatient setting, is associated with lower costs and shorter LOS,” Dr. Bryan and associates concluded. “By improving adherence to evidence-based recommendations within a clinical pathway, we may be able to provide higher-value care by optimizing the quality of bronchiolitis care at lower costs and with shorter LOS.”
Read the full study in Pediatrics (doi: 10.1542/peds.2016-3432 ).