Clinical trial NCT06932341: Leveraging Electronic Health Record Tools to Improve the Evidence-Based Treatment of Children Hospitalized With Bronchiolitis
Official title: Use of a BPA to Promote High Value Care in Bronchiolitis: A Randomized Controlled Study
Study type: INTERVENTIONAL
Overall status: RECRUITING
Phase: NA
Conditions: Bronchiolitis
Keywords: best practice advisory
clinical decision support
clinical guideline
clinical pathway
Lead sponsor: Johns Hopkins University
Sponsor class: OTHER
First posted: 2025-04-17
Enrollment: 800
Sex: ALL
Maximum age (years): 24
Standard ages: CHILD
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: TREATMENT

Brief summary: The goal of this experimental study is to learn whether different types of best practice advisories (BPAs) that direct clinicians to reference clinical guidelines embedded in the electronic health record (EHR) increase the delivery of evidence-based care in children presenting to the hospital with bronchiolitis. The main questions it aims to answer are:

* Do BPAs improve clinicians' delivery of guideline-concordant care in bronchiolitis?
* Do interruptive BPAs improve guideline-concordant care of bronchiolitis more than non-interruptive BPAs?

Researchers will compare the treatment and outcomes of patients whose clinicians did not receive a BPA, to those whose clinicians received a non-interruptive BPA, to those whose clinicians received an interruptive BPA.

Patients will continue to receive standard hospital care for bronchiolitis.

Clinicians will:

* retain access to an EHR-embedded clinical guideline for bronchiolitis care
* be exposed to either no BPA, a non-interruptive BPA, or an interruptive BPA promoting the EHR-embedded clinical guideline (randomized per patient encounter)

Detailed description: Bronchiolitis, a viral respiratory illness affecting infants and toddlers, is the most common reason children less than 2 years old are hospitalized. However, many children admitted with bronchiolitis receive unnecessary treatments that do not hasten recovery and may even cause harm. Despite evidence that the best treatment for bronchiolitis is supportive care (i.e. oxygen and hydration support), clinicians continue to overuse certain therapies, leading to longer hospital stays, higher costs, and increased stress for families.

The investigators will study the effects of BPAs, which are real-time alerts within the EHR. The BPAs in this study promote the use of an evidence-based care guideline for bronchiolitis that is embedded within the EHR. There are multiple BPA designs commonly used in EHRs: 1) interruptive BPAs, which require clinicians to interact with the alert to continue the clinician's workflow; and 2) non-interruptive BPAs, which appear as visual cues but do not require clinicians to alter workflows.

Eligibility criteria: Patient Inclusion Criteria:

* Children \<=24 months of age presenting to the emergency room and/or hospitalized (under observation or inpatient status) with bronchiolitis at one of three study sites.

Patient Exclusion Criteria:

* Current encounter is birth-encounter
* Currently hospitalized in an ICU
* Hospitalized with length of stay \>14 days

Clinician Inclusion Criteria:

* Physicians and advanced practice providers entering the patient's chart or orders entry activity for Emergency Department (ED) and inpatient encounters

Clinician Exclusion Criteria:

* Physicians and advanced practice providers who do not enter the patient's chart or orders entry activity

Primary outcomes:
measure: Composite score of guideline-discordant care per hospital encounter
timeFrame: From enrollment to the end of ED encounter (approximately <24 hours) for non-hospitalized patients; End of hospital stay (approximately 2-4 days) for hospitalized patients
Secondary outcomes:
measure: Hospital length of stay (hours)
timeFrame: From enrollment to the end of ED encounter (approximately <24 hours) for non-hospitalized patients; End of hospital stay (approximately 2-4 days) for hospitalized patients
measure: Duration of oxygen treatment (hours)
timeFrame: From enrollment to the end of ED encounter (approximately <24 hours) for non-hospitalized patients; End of hospital stay (approximately 2-4 days) for hospitalized patients
measure: Duration of high-flow nasal cannula treatment (hours)
timeFrame: From enrollment to the end of ED encounter (approximately <24 hours) for non-hospitalized patients; End of hospital stay (approximately 2-4 days) for hospitalized patients
measure: Number of Participants Transferred to intensive care unit
timeFrame: From enrollment to the end of ED encounter (approximately <24 hours) for non-hospitalized patients; End of hospital stay (approximately 2-4 days) for hospitalized patients
measure: Number of chest X-rays
timeFrame: From enrollment to the end of ED encounter (approximately <24 hours) for non-hospitalized patients; End of hospital stay (approximately 2-4 days) for hospitalized patients
measure: Number of bronchodilator treatments
timeFrame: From enrollment to the end of ED encounter (approximately <24 hours) for non-hospitalized patients; End of hospital stay (approximately 2-4 days) for hospitalized patients
measure: Time spent on subtherapeutic rates of high-flow nasal cannula (hours)
timeFrame: From enrollment to the end of hospital stay, approximately 3 days
measure: Number of Participants with Hospital readmission within 7 days
timeFrame: From enrollment to 7 days after hospital discharge
Other outcomes:
measure: Number of clinician interactions with clinical guideline
timeFrame: From enrollment to the end of ED encounter (approximately <24 hours) for non-hospitalized patients; End of hospital stay (approximately 2-4 days) for hospitalized patients
Locations:
city: Saint Petersburg
country: United States
facility: Johns Hopkins All Children's Hospital
state: Florida
city: Baltimore
country: United States
facility: Johns Hopkins Bayview Medical Center
state: Maryland
city: Baltimore
country: United States
facility: Johns Hopkins Children's Center
state: Maryland
Study officials:
affiliation: Johns Hopkins University
name: Benjamin Bodnar, MD
role: PRINCIPAL_INVESTIGATOR
References: