Low-value Care, and Variation in Practice for Children Hospitalized With Bronchiolitis
NCT Number: NCT06506474
Acronym: CareBEST
Status: RECRUITING
Study Type: OBSERVATIONAL
Conditions: Bronchiolitis
Interventions: DIAGNOSTIC_TEST: Provision of any of six different low-value health services for treatment of bronchiolitis
Sponsor: St. Justine's Hospital
Collaborators: Children's Hospital of Eastern Ontario|Maternal Infant Child and Youth Research Network|The Hospital for Sick Children|Unity Health Toronto
Sex: ALL
Age: CHILD
Enrollment: 3000
Study Design: Observational Model: |Time Perspective: p
Start Date: 2024-02-13
Completion Date: 2027-06
Locations: Alberta Children's Hospital, Calgary, Alberta, T3B 6A8, Canada|Stollery Children's Hospital, Edmonton, Alberta, T6G 2B7, Canada|British Columbia Children's Hospital, Vancouver, British Columbia, V6H 3N1, Canada|IWK Health, Halifax, Nova Scotia, B3K 6R8, Canada|McMaster Children's Hospital, Hamilton, Ontario, L8N 3Z5, Canada|Kingston Health Science Centre, Kingston, Ontario, K7L 2V7, Canada|Children's Hospital of Western Ontario (London Health Science Centre), London, Ontario, N6C 0B2, Canada|Trillium Health Partners, Mississauga, Ontario, L5B 1B8, Canada|Lakeridge Health, Oshawa, Ontario, L1G 8A2, Canada|Children's Hospital of Eastern Ontario, Ottawa, Ontario, K1H 8L1, Canada|Hospital for Sick Children, Toronto, Ontario, M5G 1E8, Canada|Centre hospitalier Cité-de-la-Santé, Laval, Quebec, H7M 3L9, Canada|Hôpital Maisonneuve-Rosemont, Montréal, Quebec, H1T 2M4, Canada|CHU Sainte-Justine, Montréal, Quebec, H3T 1C5, Canada|Montreal Children's Hospital, Montréal, Quebec, H4A 3J1, Canada|Hôpital Saint-Eustache, Saint-Eustache, Quebec, J7R 5B1, Canada|Hôpital Régional de St-Jérôme, Saint-Jérôme, Quebec, J7Z 5T3, Canada|Centre Hospitalier Université Laval - Centre Mère-Enfant Soleil, Québec, G1V 4G2, Canada

Summary:
Low-value care is defined as the use of a health service, such as diagnostics and treatments, for which the harms or costs outweigh the benefits. In pediatrics, investigations or treatments can be unpleasant or traumatizing to the child, can prolong the time spent in hospital, and can create a cascade of further futile investigations and treatments. Several of the commonly used diagnostics and treatments in bronchiolitis are considered low-value, making it a great model to study low-value care in pediatrics.

The purpose of CareBEST is to study the use of 6 low-value healthcare services in children aged 1 to 12 months hospitalized with bronchiolitis, their costs, and measure the variability in practice of these services.

The main questions this study aims to answer are:

1. How frequently are 6 low-value care health services used in children hospitalized with bronchiolitis? These 6 low-value care health services are: 1) respiratory virus testing; 2) chest x-rays; 3) continuous pulse oximetry; 4) short-acting beta-agonists; 5) systemic corticosteroids; and 6) antibiotics.

   * Are there factors that predict the use of these services?
   * What are the costs of the use of these services?
2. How much variability is there between different patients, different doctors, and between hospitals in the use of these 6 low-value health services ?
3. Are differences in use of low-value health services associated with patient and family characteristics (like race and ethnicity, socioeconomic status, language), and do these contribute to disparities in care?

Participants will have their infant's medical chart reviewed during their hospitalization. They will also have 2 short questionnaires to complete, once during their child's admission to the hospital, and one 30 days later to ask about whether their child required any additional medical care.

This analysis will provide a better understanding of treatment of bronchiolitis in Canada and help in the development of effective interventions to reduce low-value care.

Primary Outcome Measures: The proportion of eligible patients receiving each of the six low-value health services, The primary outcome of the study is the proportion of patients receiving each of the six low-value health services during their hospitalization for bronchiolitis: 1) respiratory virus testing; 2) chest x-ray; 3) continuous pulse oximetry; 4) short-acting beta-agonists; 5) systemic corticosteroids; and 6) antibiotics., 24 months
Secondary Outcome Measures: Transfer to the ICU, Whether the child admitted with bronchiolitis was transferred to the ICU. If so, duration of ICU stay., 24 months|Use of CPAP, BiPAP, or mechanical ventilation during admission., Use of continuous positive airway pressure (CPAP) or biphasic positive airway pressure (BiPAP), mechanical ventilation during admission, as documented in patient's admission record., 24 months|Cardiac arrest, Whether the child experienced a cardiac arrest during their admission., 24 months|Death, Whether the child died during their admission., 24 months|Return visits, Using administrative data and parent surveys, we will measure return visits to the Emergency Department, and hospitalizations within 30 days following the initial bronchiolitis admission, overall and for respiratory illness., 24 months|Use of low-flow supplemental oxygen, Any use of low-flow supplemental oxygen, and duration of use., 24 months|Fluid supplementation, Presence and type (intravenous vs. nasogastric) of fluid supplementation, 24 months|Nil per os order, Any order for "nil per os" (feeding not permitted) during admission., 24 months|Chest X-ray results, Results of chest X-rays ordered. Obtained from medical record., 24 months|Presence of bacterial co-infection, Presence and type of bacterial co-infections. Obtained from medical record., 24 months|Use of inhaled corticosteroids, Whether inhaled corticosteroids were administered during admission. Obtained from medical record., 24 months|Use of chest physiotherapy, Whether chest physiotherapy was performed during admission. Obtained from medical record., 24 months|Complete blood count, Results of complete blood count. Obtained from medical record. Numerical, 24 months|Electrolyte levels, Electrolyte levels in blood. Obtained from medical record. Numerical, 24 months|Venous blood gas, Results of blood tests ordered; venous blood gas. Obtained from medical record. Numerical, 24 months|Antiviral prescription, Any prescription for an antiviral effective against influenza during admission.Obtained from medical record., 24 months|Prescription at discharge from hospital, Data collection on prescription at discharge from the hospital including the following: 1) repeat chest x-ray; 2) prescription for short-acting beta-agonists (SABA); 3) inhaled corticosteroids; 4) systemic corticosteroids; 5) antibiotics; and 6) antivirals., 24 months|Care received in the 30 days following discharge., Care received in the 30 days following the patient's discharge from the hospital, including outpatient follow-up appointments in the following 30 days, follow-up chest x-rays, as well as prescription for antibiotics, short-acting beta-agonists, and inhaled corticosteroids., 24 months|Length of stay, Length of hospital stay in hours, both in the ED and inpatient unit, measured using recorded time of arrival and departure to and from the ED and inpatient unit., 24 months|Cost of hospitalization, Cost of hospitalization will be evaluated from a healthcare institution perspective with data from hospital decision support. More detailed costs data (micro-costing) will also be obtained whenever possible, allowing differentiation between services not readily discerned by traditional case costing methods typically based on resource intensity weights., 24 months|Use of Heated humidified high-flow nasal cannula (HHHFNC), Heated humidified high-flow nasal cannula (HHHFNC) help reduce work of breathing and can be beneficial in severe bronchiolitis cases. We will measure proportion of HHHFNC use in hospitalized children with bronchiolitis stratified by disease severity. Obtained from medical record., 24 months