Children's National Hospitalist Calls for National Benchmarks to Improve Care for Hospitalized Patients with Asthma, Pneumonia, and Bronchiolitis

Washington, DC – Kavita Parikh, MD, a pediatric hospitalist at Children’s National Health System, and other hospitalists across the country have recommended achievable national benchmarks to improve clinical care of patients hospitalized with asthma, pneumonia, and bronchiolitis, which are among the leading causes of pediatric hospital admissions.

“We have evidence-based guidelines for asthma, pneumonia, and bronchiolitis, but there is a variation across the board at hospitals for care, and a resultant gap between what we as clinicians should be striving for,” says Dr. Parikh, the first-author of the study, “Establishing Benchmarks for the Hospitalized Care of Children with Asthma, Bronchiolitis and Pneumonia,” published in Pediatrics.

The study included the Children’s Hospital Association and several other academic healthcare institutions. Despite the availability of national clinical practice guidelines (CPGs) for asthma, pneumonia, and bronchiolitis, continued variation of care in terms of both diagnostics and treatments has been well documented. Such variation may lead to “excess resource utilization and cost of care,” Dr. Parikh says, “which we need to tackle as we move towards more value-based care.”

Benchmarking in healthcare is used to compare the experience in areas or hospitals with local, state, national, or other areas of hospital averages.

The use of clinical quality indicators and achievable benchmarks of care (ABC) will “drive the improvement at individual hospitals,” says Dr. Parikh, also Assistant Professor of Pediatrics at the George Washington University School of Medicine and Health Sciences, who conceptualized the study, led data interpretation, and drafted the initial manuscript. “If the use of ABCs becomes institutionalized, it would allow for integrated, national efforts to decrease resource utilization and enhance the quality of care for children admitted to the hospital with these common diagnoses,” the report states. 

Regarding antibiotic prescribing patterns, the study findings showed:

Asthma – Antibiotic over-utilization for asthma has been a concern in healthcare. In 2011, nearly one in six pediatric ambulatory care visits for asthma throughout the country resulted in a prescriptions for antibiotic, without an ICD09 code to justify the use, the study said.  

Bronchiolitis – Bronchiolitis is a common respiratory tract illness caused by an infection that affects the tiny airways, known as the bronchioles that lead to the lungs, and causes difficulty in breathing. The ABC measure for antibiotics in bronchiolitis is 18.5 percent, almost half the recently reported median utilization of 37 percent. 

Pneumonia – Of great public health concern to our community is the increasing emergence of resistant bacteria, and one approach to combat this issue is to use antibiotics specific to the bacteria being treated, rather than a broad-spectrum antibiotic (ie. antibiotics that act against a wide-range of bacteria). Parikh and co-authors reported an achievable benchmark of approximately 60 percent for narrow-spectrum antibiotic utilization, compared to median performance of only 27 percent, again providing an achievable target for local quality improvement efforts.  

Contact: Joe Cantlupe at 202-476-4500.