Use of a BPA to Promote High Value Care in Bronchiolitis: A Randomized Controlled Study
Johns Hopkins University
Summary
The goal of this experimental study is to learn whether different types of best practice advisories (BPAs) that direct clinicians to reference clinical guidelines embedded in the electronic health record (EHR) increase the delivery of evidence-based care in children presenting to the hospital with bronchiolitis. The main questions it aims to answer are: * Do BPAs improve clinicians' delivery of guideline-concordant care in bronchiolitis? * Do interruptive BPAs improve guideline-concordant care of bronchiolitis more than non-interruptive BPAs? Researchers will compare the treatment and outcomes of patients whose clinicians did not receive a BPA, to those whose clinicians received a non-interruptive BPA, to those whose clinicians received an interruptive BPA. Patients will continue to receive standard hospital care for bronchiolitis. Clinicians will: * retain access to an EHR-embedded clinical guideline for bronchiolitis care * be exposed to either no BPA, a non-interruptive BPA, or an interruptive BPA promoting the EHR-embedded clinical guideline (randomized per patient encounter)
Description
Bronchiolitis, a viral respiratory illness affecting infants and toddlers, is the most common reason children less than 2 years old are hospitalized. However, many children admitted with bronchiolitis receive unnecessary treatments that do not hasten recovery and may even cause harm. Despite evidence that the best treatment for bronchiolitis is supportive care (i.e. oxygen and hydration support), clinicians continue to overuse certain therapies, leading to longer hospital stays, higher costs, and increased stress for families. The investigators will study the effects of BPAs, which are real-t…
Eligibility
- Age range
- Up to 2 years
- Sex
- All
- Healthy volunteers
- No
Patient Inclusion Criteria: * Children \<=24 months of age presenting to the emergency room and/or hospitalized (under observation or inpatient status) with bronchiolitis at one of three study sites. Patient Exclusion Criteria: * Current encounter is birth-encounter * Currently hospitalized in an ICU * Hospitalized with length of stay \>14 days Clinician Inclusion Criteria: * Physicians and advanced practice providers entering the patient's chart or orders entry activity for Emergency Department (ED) and inpatient encounters Clinician Exclusion Criteria: * Physicians and advanced practi…
Interventions
- OtherNon-interruptive
Non-interruptive BPA (appears as a visual cue but does not require clinicians to alter workflows) directing clinicians to reference the EHR-embedded, evidence-based clinical guideline for the care of bronchiolitis.
- OtherInterruptive
Interruptive BPA (requires clinicians to interact with the alert to continue the workflow) directing clinicians to reference the EHR-embedded, evidence-based clinical guideline for the care of bronchiolitis.
Locations (3)
- Johns Hopkins All Children's HospitalSt. Petersburg, Florida
- Johns Hopkins Bayview Medical CenterBaltimore, Maryland
- Johns Hopkins Children's CenterBaltimore, Maryland