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.
