The SIP Study: Simultaneously Implementing Pathways for Improving Asthma, Pneumonia, and Bronchiolitis Care for Hospitalized Children

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PROJECT SUMMARY/ABSTRACT Asthma, pneumonia, and bronchiolitis are the top causes of childhood hospitalization in the US, leading to over 350,000 hospitalizations and ≈$2 billion in costs annually. Poor guideline adoption by clinicians contributes to poor health outcomes for children hospitalized with these respiratory illnesses, including longer recovery time/hospital stay, higher rates of transfer to intensive care units, and increased risk of hospital readmission. General hospitals, such as community hospitals, primarily provide care for adults but also provide care for >70% of hospitalized children nationally. Unlike dedicated children's hospitals, community hospitals face unique challenges to achieving guideline adoption and high-quality care for children, including less access to pediatric services and limited resources for pediatric care and quality improvement. Pathways have been shown to improve clinicians' adoption of evidence-based practices/guidelines and health outcomes for children in community hospitals. Pathways are simple, visual diagrams that guide clinicians step-by-step through the evidence-based care of a specific medical condition (accessed via paper or electronically). Most hospitals implement pathways for a single medical condition at a time, but Seattle Children's Hospital developed an intervention for simultaneously implementing multiple pathways for multiple pediatric conditions. This intervention improved guideline adoption, decreased length of stay, and decreased costs; and these results were sustained. This multi-condition pathway intervention has not yet been studied in community hospitals, which face unique implementation barriers. Our objective is to identify and test pragmatic and sustainable strategies for implementing the multi-condition pathway intervention for children hospitalized with asthma, pneumonia, or bronchiolitis in community hospitals. In Aim 1 (R61), we will engage stakeholders from community hospitals in identifying barriers and facilitators of implementation and in refining the intervention. In Aim 2a (R33), we will conduct a pragmatic, cluster-randomized trial in 36 community hospitals (1:1 randomization to intervention vs. wait-list control) to determine the effects of the multi-condition pathway intervention. Our primary outcome will be adoption of 2 evidence-based practices for each condition over a sustained period of 2 years. We will also determine length of stay, ICU transfer, and readmission. During implementation, we will also measure fidelity (use of implementation strategies as intended) in hospitals receiving the intervention (n=18). In Aim 2b (R33), we will use multi-level models to determine if these strategies are associated with guideline adoption (measured in Aim 2a). Our expected outcomes will be a comprehensive understanding of how to pragmatically, sustainably implement the multi-condition pathway intervention in community hospitals and an assessment of its effects. These outcomes will have an important positive impact by providing evidence on an intervention that can leverage implementation resources by tackling multiple pathways and rapidly improve care and outcomes for children with respiratory illnesses.