Bronchiolitis Acute
Conditions
Brief summary
Although automatic follow-up is a nearly universal practice, research has shown that these visits are often unnecessary after hospitalizations caused by bronchiolitis. Despite endorsement by national pediatric authorities, robust evidence, and family enthusiasm for as-needed (PRN) follow-up, it remains substantially underutilized for children hospitalized for bronchiolitis. The goal of I-DECIDE is to compare the effects of two multi-component implementation strategies, both of which aim to (a) increase PRN follow-up prescribing by hospitalists (physicians who care for hospitalized children) and (b) decrease unnecessary follow-up visit attendance by families.
Interventions
OTHERModerate-Resource Implementation Strategy
The moderate-resource implementation strategy includes educational outreach (including family-facing materials to support follow-up decision making), audit and feedback (review of clinician performance, captured in a structured report), and materials for clinical decision support.
OTHERHigh-Resource Implementation Strategy
The high-resource implementation strategy includes all of the moderate resource components, plus two forms of external facilitation: small-group facilitation and expert clinical decision support coach-led facilitation. In total, the high-resource implementation strategy includes educational outreach (including family-facing materials to support follow-up decision-making), audit and feedback (review of clinician performance, captured in a structured report), materials for clinical decision support, small-group facilitation and expert clinical decision support coach-led facilitation.
Sponsors
Seattle Children's Hospital
Patient-Centered Outcomes Research Institute
Children's Hospital of Philadelphia
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
0 Months to 24 Months
Healthy volunteers
No
Inclusion criteria
* Primary diagnosis of bronchiolitis, discharged by a generalist inpatient service from a non-ICU, non-emergency department, non-step down unit
Exclusion criteria
* Children with a history of gestational age \<28 weeks, chronic lung disease, complex or hemodynamically significant heart disease, immunodeficiency, or neuromuscular disease * Children being discharged with home oxygen therapy
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Adoption | Within 7 days of hospital discharge | Proportion of participants who are prescribed PRN follow-up |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Sustainment | Within 7 days of hospital discharge | Proportion of participants who attend a follow-up visit |
Countries
Canada, United States
Contacts
CONTACTEric Coon, MD, MS
CONTACTChris Bonafide, MD, MSCE
Outcome results
None listed