Researchers from Children’s Hospital of Philadelphia (CHOP) and Seattle Children’s Research Institute have received funding support from the Patient-Centered Outcomes Research Institute (PCORI) to study the best implementation strategies to promote a new and evidence-based approach: as-needed follow up after a hospitalization for bronchiolitis.
Typically, doctors tell families to take a child to a follow-up visit with their primary care doctor within seven days of hospitalization, regardless of whether the child’s symptoms resolve. However, prior research has demonstrated that after an infection with bronchiolitis, which is relatively common, as-needed follow-up is more appropriate than universally sending all children for follow-up. This would mean that families would only follow up with their primary care doctor if they had new concerns or if their child’s symptoms did not resolve, thereby empowering families to make personalized decisions based on their child’s unique needs after leaving the hospital. Studies have reported families liking the as-needed option, which could also save resources and protect limited appointment slots for other children who need them.
“When your child is hospitalized, it’s an especially stressful time for families and could lead to lost income, challenging transportation arrangements and other obstacles,” said Chris Bonafide, MD, MSCE, Associate Chief of the Division of General Pediatrics and Co-Associate Director for Implementation Science of Clinical Futures at CHOP. “Prior studies have demonstrated that in the case of bronchiolitis, rushing back into the doctor’s office to follow up in the days immediately after discharge is not necessary for most children, and avoiding unnecessary follow-up could reduce the number of burdens faced by families.”
In this PCORI-funded project titled Implementing family Directed and Empowered Care with Infant Discharge Evidence (I-DECIDE), researchers will test two different strategies to increase the number of as-needed follow-up recommendations by doctors and decrease the amount of unnecessary follow-up visits for families of children hospitalized by bronchiolitis.
Bonafide and Eric Coon, MD, attending physician and researcher at Seattle Children's Research Institute and an Executive Council member for the Pediatric Research in Inpatient Settings (PRIS) Network, will lead this study and collaborate with a network of 60 hospitals across the United States, with the goal of enrolling 2700 children hospitalized for bronchiolitis for this study.
Half of the hospitals will use methods that have been commonly used to improve other kinds of care in hospitals – such as clinical education, guidance for families and computer tools – and apply them to support greater use of as-needed hospitals. The other half will use all of those methods plus a facilitation strategy that involves experts helping hospitals by guiding leaders and figuring out ways of overcoming barriers to the increased use of as-needed follow-up care. By comparing the two, the study will determine whether more resources result in more widespread, sustained implementation.
“We believe this work will empower families by putting this decision in their hands,” Coon said. “We’re not saying that no one should follow up, but rather parents can make a personalized decision by monitoring symptoms and using their own judgment regarding next steps.”
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Researchers from Children’s Hospital of Philadelphia (CHOP) and Seattle Children’s Research Institute have received funding support from the Patient-Centered Outcomes Research Institute (PCORI) to study the best implementation strategies to promote a new and evidence-based approach: as-needed follow up after a hospitalization for bronchiolitis.
Typically, doctors tell families to take a child to a follow-up visit with their primary care doctor within seven days of hospitalization, regardless of whether the child’s symptoms resolve. However, prior research has demonstrated that after an infection with bronchiolitis, which is relatively common, as-needed follow-up is more appropriate than universally sending all children for follow-up. This would mean that families would only follow up with their primary care doctor if they had new concerns or if their child’s symptoms did not resolve, thereby empowering families to make personalized decisions based on their child’s unique needs after leaving the hospital. Studies have reported families liking the as-needed option, which could also save resources and protect limited appointment slots for other children who need them.
“When your child is hospitalized, it’s an especially stressful time for families and could lead to lost income, challenging transportation arrangements and other obstacles,” said Chris Bonafide, MD, MSCE, Associate Chief of the Division of General Pediatrics and Co-Associate Director for Implementation Science of Clinical Futures at CHOP. “Prior studies have demonstrated that in the case of bronchiolitis, rushing back into the doctor’s office to follow up in the days immediately after discharge is not necessary for most children, and avoiding unnecessary follow-up could reduce the number of burdens faced by families.”
In this PCORI-funded project titled Implementing family Directed and Empowered Care with Infant Discharge Evidence (I-DECIDE), researchers will test two different strategies to increase the number of as-needed follow-up recommendations by doctors and decrease the amount of unnecessary follow-up visits for families of children hospitalized by bronchiolitis.
Bonafide and Eric Coon, MD, attending physician and researcher at Seattle Children's Research Institute and an Executive Council member for the Pediatric Research in Inpatient Settings (PRIS) Network, will lead this study and collaborate with a network of 60 hospitals across the United States, with the goal of enrolling 2700 children hospitalized for bronchiolitis for this study.
Half of the hospitals will use methods that have been commonly used to improve other kinds of care in hospitals – such as clinical education, guidance for families and computer tools – and apply them to support greater use of as-needed hospitals. The other half will use all of those methods plus a facilitation strategy that involves experts helping hospitals by guiding leaders and figuring out ways of overcoming barriers to the increased use of as-needed follow-up care. By comparing the two, the study will determine whether more resources result in more widespread, sustained implementation.
“We believe this work will empower families by putting this decision in their hands,” Coon said. “We’re not saying that no one should follow up, but rather parents can make a personalized decision by monitoring symptoms and using their own judgment regarding next steps.”
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