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

项目摘要/摘要 哮喘、肺炎和毛细支气管炎是美国儿童住院的主要原因，导致 每年350,000次住院治疗和20亿美元的≈成本。临床医生采用指南的情况不佳 导致患有这些呼吸道疾病住院的儿童健康状况不佳，包括 更长的康复时间/住院时间，更高的转入重症监护病房的比率，以及更高的住院风险 重新入院。综合医院，如社区医院，主要为成年人提供护理，但也提供 照顾全国70%的住院儿童。与专门的儿童医院不同，社区医院 在通过准则和为儿童提供高质量护理方面面临独特的挑战，包括获得更少的机会 儿科服务和用于儿科护理和提高质量的有限资源。路径一直是 显示可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、直观的示意图，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获取)。大多数医院 一次为一种疾病实施路径，但西雅图儿童医院开发了一种 针对多种儿科疾病同时实施多条路径的干预。这 干预改善了指南的采用，减少了住院时间，并降低了成本；这些结果 是持续的。这种多条件途径干预还没有在社区中得到研究 医院，它们面临着独特的实施障碍。我们的目标是确定和测试务实和 对住院儿童实施多条件路径干预的可持续策略 社区医院的哮喘、肺炎或毛细支气管炎。在目标1(R61)中，我们将从 社区医院在确定执行障碍和促进者以及完善干预措施方面发挥了重要作用。在……里面 目标2a(R33)，我们将在36家社区医院(1：1)进行一项务实的整群随机试验 干预与等待名单对照的随机化)以确定多条件途径的效果 干预。我们的主要成果将是针对每种情况采取2项循证实践 持续期2年。我们还将决定住院时间、ICU转院和重新入院。在.期间 在实施过程中，我们还将衡量医院的忠诚度(按预期使用实施战略) 接受干预(n=18)。在Aim 2b(R33)中，我们将使用多层次模型来确定这些 战略与准则采纳有关(在目标2a中衡量)。我们的预期结果将是 全面理解如何务实、可持续地实施多条件途径 社区医院的干预措施及其效果评估。这些结果将对 通过提供有关可通过以下方式利用实施资源的干预措施的证据，产生积极影响 应对多种途径，迅速改善对患有呼吸系统疾病的儿童的护理和预后。

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.