De-implementation of low-value bronchiolitis practices showed sustained adherence two years post-trial in a cluster RCT follow-up.
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Key Takeaway
Note sustained adherence to de-implemented low-value bronchiolitis practices two years post-trial, though safety data were not reported.
This cluster randomised controlled trial (cRCT) follow-up study evaluated the sustainability of de-implementing low-value practices in bronchiolitis management. The intervention involved hospitals stopping chest radiography, salbutamol, glucocorticoids, antibiotics, and epinephrine use, compared with control hospitals that did not receive this intervention. The population included 3299 infants one year post-trial and 1689 infants two years post-trial across 26 Australian and New Zealand hospitals.
Two years after the trial completion, adherence with no use of the five low-value practices was 80.9%. The adjusted predicted adherence was 80.8%, with a 95% CI of 77.4% to 84.2%. The estimated risk difference from the cRCT outcome was -3.9% (95% CI: -8.6% to 0.8%), which was fulfilling the a priori definition of sustainability defined as no more than a <7% decrease to any level of improvement in adherence for all five low-value practices.
Safety and tolerability data, including adverse events, serious adverse events, and discontinuations, were not reported. Funding or conflicts of interest were also not reported. The study provides evidence for sustainability in de-implementing low-value care in bronchiolitis management, though the lack of safety reporting limits the ability to assess long-term risk in this setting.
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View Original Abstract ↓
BACKGROUND: In 2017, the PREDICT (Paediatric Research in Emergency Departments International Collaborative) network conducted a cluster randomised controlled trial (cRCT) at 26 Australian and New Zealand hospitals to improve bronchiolitis care. Findings demonstrated that targeted interventions significantly improved adherence with five evidence-based low-value bronchiolitis practices (no chest radiography, salbutamol, glucocorticoids, antibiotics and epinephrine) in the first 24 hours of hospitalisation (adjusted risk difference, 14.1%; 95% CI: 6.5% to 21.7%; p<0.001). During the intervention year (2017), intervention hospital (n=13) compliance was 85.1% (95% CI: 82.6% to 89.7%). This study aimed to determine if improvements in bronchiolitis management were sustained at intervention hospitals 2 years post-trial completion.
METHODS: International, multicentre follow-up study of hospitals in Australia and New Zealand that participated in a cRCT of de-implementation of low-value bronchiolitis practices, 1 year (2018) and 2 years (2019) post-trial completion, obtained retrospectively from medical audits. Sustainability was defined a priori as no more than a <7% decrease to any level of improvement in adherence for all five low-value practices (composite outcome) from the cRCT intervention year.
RESULTS: Of the 26 hospitals, 11 intervention and 10 control hospitals agreed to participate in the follow-up study. Data were collected on 3299 infants with bronchiolitis 1 year (intervention and control hospitals) and 1689 infants 2 years post-trial (intervention hospitals). Adherence with no use of the five low-value practices 2 years post-trial completion was 80.9% (adjusted predicted adherence, 80.8%, 95% CI: 77.4% to 84.2%; estimated risk difference from cRCT outcome -3.9%, 95% CI: -8.6% to 0.8%) at intervention hospitals, fulfilling the a priori definition of sustainability.
DISCUSSION: Targeted interventions, delivered over one bronchiolitis season, resulted in sustained improvements in bronchiolitis management in infants 2 years later. This follow-up study provides evidence for sustainability in de-implementing low-value care in bronchiolitis management.
TRIAL REGISTRATION DETAILS: Australian and New Zealand Clinical Trials Registry No: ACTRN12621001287820.
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