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

项目概要/摘要 哮喘、肺炎和细支气管炎是美国儿童住院的主要原因， 每年有35万人住院治疗，花费20亿美元。临床医生对指南的采用较差 导致因这些呼吸道疾病住院的儿童健康状况不佳， 恢复时间/住院时间更长，转入重症监护室的比率更高，住院风险增加 再入院综合医院，如社区医院，主要为成年人提供护理，但也提供 为全国超过70%的住院儿童提供护理。与专门的儿童医院不同， 在实现儿童的指导收养和高质量护理方面面临着独特的挑战，包括更少的机会 儿科服务和有限的资源用于儿科护理和质量改进。途径已经 显示改善临床医生采用循证实践/指南和儿童健康结果 在社区医院。路径是简单的可视化图表，可指导临床医生逐步完成 对特定医疗状况的循证护理（通过纸质或电子方式访问）。大多数医院 一次实施一种医疗条件的途径，但西雅图儿童医院开发了一种 为多种儿科疾病同时实施多种途径的干预。这 干预改善了指南的采用，缩短了住院时间，降低了成本;这些结果 是有效的。这种多条件路径干预尚未在社区进行研究 医院面临独特的实施障碍。我们的目标是确定和测试务实和 实施多条件路径干预的可持续策略 哮喘、肺炎或细支气管炎。在目标1（R61）中，我们将邀请来自以下方面的利益相关者参与： 社区医院在确定实施的障碍和促进因素以及改进干预措施方面的作用。在 目的2a（R33），我们将在36家社区医院（1：1）进行一项务实的随机分组试验 随机化干预与等待列表对照），以确定多条件途径的影响 干预我们的主要结果将是采用2个循证实践为每一个条件超过一个 持续两年。我们还将确定住院时间、ICU转移和再入院。期间 实施，我们还将衡量医院的忠诚度（按预期使用实施策略） 接受干预（n=18）。在目标2b（R33）中，我们将使用多层次模型来确定这些 战略与准则的采用有关（在目标2a中衡量）。我们的预期结果将是 全面了解如何务实、可持续地实施多条件途径 在社区医院进行干预并评估其效果。这些成果将对 通过提供干预措施的证据产生积极影响， 解决多种途径，并迅速改善呼吸道疾病儿童的护理和结果。

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.