Association of Bronchiolitis Clinical Pathway Adherence With Length of Stay and Costs

Abstract

OBJECTIVES: To examine the associations between the level of adherence to bronchiolitis clinical pathway recommendations, health care use, and costs. METHODS: We conducted a retrospective cohort study of 267 patients ≤24 months old diagnosed with bronchiolitis from 12/2009 to 7/2012. Clinical pathway adherence was assessed by using a standardized scoring system (0–100) for 18 quality measures obtained by medical record review. Level of adherence was categorized into low, middle, and high tertiles. Generalized linear models were used to examine relationships between adherence tertile and (1) length of stay (LOS) and (2) costs. Logistic regression was used to examine the associations between adherence tertile and probability of inpatient admission and 7-day readmissions. RESULTS: Mean adherence scores were: ED, 78.8 (SD, 18.1; n = 264), inpatient, 95.0 (SD, 6.3; n = 216), and combined ED/inpatient, 89.1 (SD, 8.1; n = 213). LOS was significantly shorter for cases in the highest versus the lowest adherence tertile (ED, 90 vs 140 minutes, adjusted difference, –51 [95% confidence interval (CI), –73 to –29; P <.05]; inpatient, 3.1 vs 3.8 days, adjusted difference, –0.7 [95% CI, –1.4 to 0.0; P <.05]). Costs were less for cases in the highest adherence tertile (ED, –$84, [95% CI, –$7 to –$161; P <.05], total, –$1296 [95% CI, –126.43 to –2466.03; P <.05]). ED cases in the highest tertile had a lower odds of admission (odds ratio, 0.38 [95% CI, 0.15–0.97; P < .05]). Readmissions did not differ by tertile. CONCLUSIONS: High adherence to bronchiolitis clinical pathway recommendations across care settings was associated with shorter LOS and lower cost.