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DOI: 10.1055/s-0039-1679868
Timely Data for Targeted Quality Improvement Interventions: Use of a Visual Analytics Dashboard for Bronchiolitis
Funding None.Publikationsverlauf
19. September 2018
10. Januar 2019
Publikationsdatum:
06. März 2019 (online)
![](https://www.thieme-connect.de/media/10.1055-s-00035026/201901/lookinside/thumbnails/10-1055-s-0039-1679868_180192cr-1.jpg)
Abstract
Background Standard methods for obtaining data may delay quality improvement (QI) interventions including for bronchiolitis, a common cause of childhood hospitalization.
Objective To describe the use of a dashboard in the context of a multifaceted QI intervention aimed at reducing the use of chest radiographs, bronchodilators, antibiotics, steroids, and viral testing in patients with bronchiolitis.
Methods This QI initiative took place at Children's Minnesota, a large, not-for-profit children's health care organization. A multidisciplinary bronchiolitis workgroup developed a local clinical guideline and order-set. Delays in obtaining baseline data prompted a pediatric hospitalist and information technology specialist to modify a vendor's dashboard to display data related to bronchiolitis guideline metrics. Patients 2 months to 2 years old with a bronchiolitis emergency department (ED)/inpatient encounter in the period October 1, 2014 to April 30, 2018 were included. The primary outcome was a functioning dashboard; a process measure was the percentage of ED clinician logins. Outcome measures included the percent use of guideline metrics (e.g., bronchodilators) displayed on statistical process control charts (ED vs. inpatient). Balancing measures included length of stay, charge ratios, and hospital revisits.
Results A workgroup (formed October 2015) implemented a bronchiolitis order-set and guideline (February 2016) followed by a bronchiolitis dashboard (August 2016) consolidating disparate data sources loaded within 2 to 4 days of discharge. In total, 35% of ED clinicians logged in. Leaders used the dashboard to target and track interventions such as a bronchodilator order alert. There were improvements in most outcome metrics; however, timing did not suggest direct dashboard impact. ED balancing measures were lower after implementation.
Conclusion We described use of a dashboard to support a multifaceted QI initiative for bronchiolitis. Leaders used the dashboard for targeted interventions but the dashboard did not directly impact the observed improvements. Future studies should assess reasons for low individual dashboard use.
Authors' Contributions
Dr. Hester conceptualized and designed the study, led the implementation of the guideline, assisted in dashboard development, drafted the initial manuscript, performed statistical analyses, prepared several figures, and approved the final manuscript as submitted. Mr. Lang was the IT dashboard developer and led dashboard development, performed analyses, prepared several figures, critically reviewed the manuscript, and approved the final manuscript as submitted. Ms. Madsen and Dr. Tambyraja were IT leaders who assisted with organizational dashboard implementation, assisted in bronchiolitis dashboard development, participated in the guideline review, critically reviewed the manuscript, and approved the final manuscript as submitted. Dr. Zenker was an emergency department lead for the guideline implementation, assisted in dashboard development, critically reviewed the manuscript, and approved the final manuscript as submitted.
Protection of Human and Animal Subjects
There were no implications (e.g., financial) to clinicians as a result of this initiative. This study was deemed QI and exempt from further review by the organization's Institutional Review Board.
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References
- 1 Woolf SH, Grol R, Hutchinson A, Eccles M, Grimshaw J. Clinical guidelines: potential benefits, limitations, and harms of clinical guidelines. BMJ 1999; 318 (7182): 527-530
- 2 Ralston SL, Lieberthal AS, Meissner HC. , et al; American Academy of Pediatrics. Clinical practice guideline: the diagnosis, management, and prevention of bronchiolitis. Pediatrics 2014; 134 (05) e1474-e1502
- 3 Keren R, Luan X, Localio R. , et al; Pediatric Research in Inpatient Settings (PRIS) Network. Prioritization of comparative effectiveness research topics in hospital pediatrics. Arch Pediatr Adolesc Med 2012; 166 (12) 1155-1164
- 4 Akenroye AT, Baskin MN, Samnaliev M, Stack AM. Impact of a bronchiolitis guideline on ED resource use and cost: a segmented time-series analysis. Pediatrics 2014; 133 (01) e227-e234
- 5 Riese J, Porter T, Fierce J, Riese A, Richardson T, Alverson BK. Clinical outcomes of bronchiolitis after implementation of a general ward high flow nasal cannula guideline. Hosp Pediatr 2017; 7 (04) 197-203
- 6 Parikh K, Hall M, Teach SJ. Bronchiolitis management before and after the AAP guidelines. Pediatrics 2014; 133 (01) e1-e7
- 7 Mittal V, Hall M, Morse R. , et al. Impact of inpatient bronchiolitis clinical practice guideline implementation on testing and treatment. J Pediatr 2014; 165 (03) 570.e3-576.e3
- 8 Muething S, Schoettker PJ, Gerhardt WE, Atherton HD, Britto MT, Kotagal UR. Decreasing overuse of therapies in the treatment of bronchiolitis by incorporating evidence at the point of care. J Pediatr 2004; 144 (06) 703-710
- 9 Florin TA, Byczkowski T, Ruddy RM, Zorc JJ, Test M, Shah SS. Variation in the management of infants hospitalized for bronchiolitis persists after the 2006 American Academy of Pediatrics bronchiolitis guidelines. J Pediatr 2014; 165 (04) 786-792
- 10 Ralston S, Garber M, Narang S. , et al. Decreasing unnecessary utilization in acute bronchiolitis care: results from the value in inpatient pediatrics network. J Hosp Med 2013; 8 (01) 25-30
- 11 Ralston S, Comick A, Nichols E, Parker D, Lanter P. Effectiveness of quality improvement in hospitalization for bronchiolitis: a systematic review. Pediatrics 2014; 134 (03) 571-581
- 12 Mussman GM, Lossius M, Wasif F. , et al. Multisite emergency department inpatient collaborative to reduce unnecessary bronchiolitis care. Pediatrics 2018; 141 (02) e20170830
- 13 Gould NJ, Lorencatto F, Stanworth SJ. , et al. Application of theory to enhance audit and feedback interventions to increase the uptake of evidence-based transfusion practice: an intervention development protocol. Implement Sci 2014; 9: 92
- 14 Ivers N, Jamtvedt G, Flottorp S. , et al. Audit and feedback: effects on professional practice and healthcare outcomes. Cochrane Database Syst Rev 2012; (06) CD000259
- 15 Prokosch HU, Ganslandt T. Perspectives for medical informatics. Reusing the electronic medical record for clinical research. Methods Inf Med 2009; 48 (01) 38-44
- 16 Embi PJ, Payne PRO. Clinical research informatics: challenges, opportunities and definition for an emerging domain. J Am Med Inform Assoc 2009; 16 (03) 316-327
- 17 Shailam R, Botwin A, Stout M, Gee MS. Real-time electronic dashboard technology and its use to improve pediatric radiology workflow. Curr Probl Diagn Radiol 2018; 47 (01) 3-5
- 18 Shaw SJ, Jacobs B, Stockwell DC, Futterman C, Spaeder MC. Effect of a real-time pediatric ICU safety bundle dashboard on quality improvement measures. Jt Comm J Qual Patient Saf 2015; 41 (09) 414-420
- 19 James SH, Kimberlin DW. Neonatal herpes simplex virus infection. Infect Dis Clin North Am 2015; 29 (03) 391-400
- 20 Koopman RJ, Kochendorfer KM, Moore JL. , et al. A diabetes dashboard and physician efficiency and accuracy in accessing data needed for high-quality diabetes care. Ann Fam Med 2011; 9 (05) 398-405
- 21 Fox LA, Walsh KE, Schainker EG. The creation of a pediatric hospital medicine dashboard: performance assessment for improvement. Hosp Pediatr 2016; 6 (07) 412-419
- 22 Pageler NM, Longhurst CA, Wood M. , et al. Use of electronic medical record-enhanced checklist and electronic dashboard to decrease CLABSIs. Pediatrics 2014; 133 (03) e738-e746
- 23 Mussman GM, Conway PH. Pediatric hospitalist systems versus traditional models of care: effect on quality and cost outcomes. J Hosp Med 2012; 7 (04) 350-357
- 24 Hain PD, Daru J, Robbins E. , et al. A proposed dashboard for pediatric hospital medicine groups. Hosp Pediatr 2012; 2 (02) 59-68
- 25 Karami M, Langarizadeh M, Fatehi M. Evaluation of effective dashboards: key concepts and criteria. Open Med Inform J 2017; 11 (01) 52-57
- 26 Simpao AF, Ahumada LM, Larru Martinez B. , et al. Design and implementation of a visual analytics electronic antibiogram within an electronic health record system at a tertiary pediatric hospital. Appl Clin Inform 2018; 9 (01) 37-45
- 27 Wanderer JP, Gruss CL, Ehrenfeld JM. Using visual analytics to determine the utilization of preoperative anesthesia assessments. Appl Clin Inform 2015; 6 (04) 629-637
- 28 Caban JJ, Gotz D. Visual analytics in healthcare--opportunities and research challenges. J Am Med Inform Assoc 2015; 22 (02) 260-262
- 29 Thomas JJ, Cook KA. A visual analytics agenda. IEEE Comput Graph Appl 2006; 26 (01) 10-13
- 30 Ratwani RM, Fong A. ‘Connecting the dots’: leveraging visual analytics to make sense of patient safety event reports. J Am Med Inform Assoc 2015; 22 (02) 312-317
- 31 Radhakrishnan K, Monsen KA, Bae S-H, Zhang W. ; Clinical Relevance for Quality Improvement. Visual analytics for pattern discovery in home care. Appl Clin Inform 2016; 7 (03) 711-730
- 32 Cerner. Available at: https://www.cerner.com/ . Accessed May 29, 2018
- 33 Qlik. Available at: www.qlik.com . Accessed January 1, 2018
- 34 Parikh K, Hall M, Mittal V. , et al. Establishing benchmarks for the hospitalized care of children with asthma, bronchiolitis, and pneumonia. Pediatrics 2014; 134 (03) 555-562
- 35 Feudtner C, Feinstein JA, Zhong W, Hall M, Dai D. Pediatric complex chronic conditions classification system version 2: updated for ICD-10 and complex medical technology dependence and transplantation. BMC Pediatr 2014; 14: 199
- 36 Stata Statistical Software. Release 13. Available at: https://www.stata.com/support/faqs/resources/citing-software-documentation-faqs/ . Accessed January 31, 2019
- 37 Perron CE, Bachur RG, Stack AM. Development, implementation, and use of an emergency physician performance dashboard. Clin Pediatr Emerg Med 2017; 18 (02) 115-123
- 38 Ralston SL, Atwood EC, Garber MD, Holmes AV. What works to reduce unnecessary care for bronchiolitis? A qualitative analysis of a national collaborative. Acad Pediatr 2017; 17 (02) 198-204
- 39 Venkatesh V, Bala H. Technology acceptance model 3 and a research agenda on interventions. Decis Sci 2008; 39 (02) 273-315
- 40 Rahimi B, Nadri H, Lotfnezhad Afshar H, Timpka T. A systematic review of the technology acceptance model in health informatics. Appl Clin Inform 2018; 9 (03) 604-634
- 41 Langley G, Moen RD, Nolan KM, Nolan TW, Norman CL, Provost LP. The Improvement Guide: A Practical Approach to Enhancing Organizational Performance. 2nd ed. San Francisco, CA: Jossey-Bass; 2009
- 42 Genies MC, Kim JM, Pyclik K, Rossi S, Spicyn N, Serwint JR. Impact of an educational intervention to improve physician adherence to bronchiolitis clinical practice guidelines: a pre-post intervention study. Clin Pediatr (Phila) 2018; 57 (03) 253-258
- 43 McCulloh RJ, Smitherman S, Adelsky S. , et al. Hospitalist and nonhospitalist adherence to evidence-based quality metrics for bronchiolitis. Hosp Pediatr 2012; 2 (01) 19-25
- 44 Cabana MD, Rand CS, Powe NR. , et al. Why don't physicians follow clinical practice guidelines? A framework for improvement. JAMA 1999; 282 (15) 1458-1465
- 45 Casey Jr DE. Why don't physicians (and patients) consistently follow clinical practice guidelines?. JAMA Intern Med 2013; 173 (17) 1581-1583
- 46 Bryan MA, Desai AD, Wilson L, Wright DR, Mangione-Smith R. Association of bronchiolitis clinical pathway adherence with length of stay and costs. Pediatrics 2017; 139 (03) e20163432
- 47 Dowding D, Merrill JA. The development of heuristics for evaluation of dashboard visualizations. Appl Clin Inform 2018; 9 (03) 511-518