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https://hdl.handle.net/1959.11/58603
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DC Field | Value | Language |
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dc.contributor.author | Haskell, Libby | en |
dc.contributor.author | Tavender, Emma J | en |
dc.contributor.author | Wilson, Catherine L | en |
dc.contributor.author | O'Brien, Sharon | en |
dc.contributor.author | Babl, Franz E | en |
dc.contributor.author | Borland, Meredith L | en |
dc.contributor.author | Cotterell, Elizabeth | en |
dc.contributor.author | Schembri, Rachel | en |
dc.contributor.author | Orsini, Francesca | en |
dc.contributor.author | Sheridan, Nicolette | en |
dc.contributor.author | Johnson, David W | en |
dc.contributor.author | Oakley, Ed | en |
dc.contributor.author | Dalziel, Stuart R | en |
dc.date.accessioned | 2024-04-23T23:53:45Z | - |
dc.date.available | 2024-04-23T23:53:45Z | - |
dc.date.issued | 2021-08 | - |
dc.identifier.citation | JAMA pediatrics, 175(8), p. 797-806 | en |
dc.identifier.issn | 2168-6211 | en |
dc.identifier.issn | 2168-6203 | en |
dc.identifier.uri | https://hdl.handle.net/1959.11/58603 | - |
dc.description.abstract | <p><b>IMPORTANCE</b> In developed countries, bronchiolitis is the most common reason for infants to be admitted to the hospital, and all international bronchiolitis guidelines recommend supportive care" however, significant variation in practice continues with infants receiving non–evidence-based therapies. Deimplementation research aims to reduce the use of low-value care, and advancing science in this area is critical to delivering evidence-based care.</p> <p><b>OBJECTIVE</b> To determine the effectiveness of targeted interventions vs passive dissemination of an evidence-based bronchiolitis guideline in improving treatment of infants with bronchiolitis.</p> <p><b>DESIGN, SETTING, AND PARTICIPANTS</b> This international, multicenter cluster randomized clinical trial included 26 hospitals (clusters) in Australia and New Zealand providing tertiary or secondary pediatric care (13 randomized to intervention, 13 to control) during the 2017 bronchiolitis season. Data were collected on 8003 infants for the 3 bronchiolitis seasons (2014-2016) before the implementation period and 3727 infants for the implementation period (2017 bronchiolitis season, May 1-November 30). Data were analyzed from November 16, 2018, to December 9, 2020.</p> <p><b>INTERVENTIONS</b> Interventions were developed using theories of behavior change to target key factors that influence bronchiolitis management. These interventions included site-based clinical leads, stakeholder meetings, a train-the-trainer workshop, targeted educational delivery, other educational and promotional materials, and audit and feedback.</p> <p><b>MAIN OUTCOMES AND MEASURES</b> The primary outcome was compliance during the first 24 hours of care with no use of chest radiography, albuterol, glucocorticoids, antibiotics, and epinephrine, measured retrospectively from medical records of randomly selected infants with bronchiolitis who presented to the hospital. There were no patient-level exclusions.</p> <p><b>RESULTS</b> A total of 26 hospitals were randomized without dropouts. Analysis was by intention to treat. Baseline data collected on 8003 infants for 3 bronchiolitis seasons (2014-2016) before the implementation period were similar between intervention and control hospitals. Implementation period data were collected on 3727 infants, including 2328 boys (62%) and 1399 girls (38%), with a mean (SD) age of 6.0 (3.2) months. A total of 459 (12%) were Māori (New Zealand), and 295 (8%) were Aboriginal/Torres Strait Islander (Australia). Compliance with recommendations was 85.1% (95% CI, 82.6%-89.7%) in intervention hospitals vs 73.0% (95% CI, 65.3%-78.8%) in control hospitals (adjusted risk difference, 14.1%" 95% CI, 6.5%-21.7%" P < .001).</p> <p><b>CONCLUSIONS AND RELEVANCE</b> Targeted interventions led to improved treatment of infants with bronchiolitis. This study has important implications for bronchiolitis management and the development of effective interventions to deimplement low-value care.</p> | en |
dc.language | en | en |
dc.publisher | American Medical Association | en |
dc.relation.ispartof | JAMA pediatrics | en |
dc.rights | Attribution 4.0 International | * |
dc.rights.uri | http://creativecommons.org/licenses/by/4.0/ | * |
dc.title | Effectiveness of Targeted Interventions on Treatment of Infants With Bronchiolitis: A Randomized Clinical Trial | en |
dc.type | Journal Article | en |
dc.identifier.doi | 10.1001/jamapediatrics.2021.0295 | en |
dcterms.accessRights | UNE Green | en |
local.contributor.firstname | Libby | en |
local.contributor.firstname | Emma J | en |
local.contributor.firstname | Catherine L | en |
local.contributor.firstname | Sharon | en |
local.contributor.firstname | Franz E | en |
local.contributor.firstname | Meredith L | en |
local.contributor.firstname | Elizabeth | en |
local.contributor.firstname | Rachel | en |
local.contributor.firstname | Francesca | en |
local.contributor.firstname | Nicolette | en |
local.contributor.firstname | David W | en |
local.contributor.firstname | Ed | en |
local.contributor.firstname | Stuart R | en |
local.relation.isfundedby | NHMRC | en |
dc.contributor.corporate | PREDICT Network | en |
local.profile.school | School of Rural Medicine | en |
local.profile.email | ecotter2@une.edu.au | en |
local.output.category | C1 | en |
local.grant.number | 1058560 | en |
local.record.place | au | en |
local.record.institution | University of New England | en |
local.publisher.place | United States of America | en |
local.format.startpage | 797 | en |
local.format.endpage | 806 | en |
local.peerreviewed | Yes | en |
local.identifier.volume | 175 | en |
local.identifier.issue | 8 | en |
local.title.subtitle | A Randomized Clinical Trial | en |
local.access.fulltext | Yes | en |
local.contributor.lastname | Haskell | en |
local.contributor.lastname | Tavender | en |
local.contributor.lastname | Wilson | en |
local.contributor.lastname | O'Brien | en |
local.contributor.lastname | Babl | en |
local.contributor.lastname | Borland | en |
local.contributor.lastname | Cotterell | en |
local.contributor.lastname | Schembri | en |
local.contributor.lastname | Orsini | en |
local.contributor.lastname | Sheridan | en |
local.contributor.lastname | Johnson | en |
local.contributor.lastname | Oakley | en |
local.contributor.lastname | Dalziel | en |
dc.identifier.staff | une-id:ecotter2 | en |
local.profile.orcid | 0000-0001-8469-8394 | en |
local.profile.role | author | en |
local.profile.role | author | en |
local.profile.role | author | en |
local.profile.role | author | en |
local.profile.role | author | en |
local.profile.role | author | en |
local.profile.role | author | en |
local.profile.role | author | en |
local.profile.role | author | en |
local.profile.role | author | en |
local.profile.role | author | en |
local.profile.role | author | en |
local.profile.role | author | en |
local.identifier.unepublicationid | une:1959.11/58603 | en |
local.date.onlineversion | 2021-04-12 | - |
dc.identifier.academiclevel | Academic | en |
dc.identifier.academiclevel | Academic | en |
dc.identifier.academiclevel | Academic | en |
dc.identifier.academiclevel | Academic | en |
dc.identifier.academiclevel | Academic | en |
dc.identifier.academiclevel | Academic | en |
dc.identifier.academiclevel | Academic | en |
dc.identifier.academiclevel | Academic | en |
dc.identifier.academiclevel | Academic | en |
dc.identifier.academiclevel | Academic | en |
dc.identifier.academiclevel | Academic | en |
dc.identifier.academiclevel | Academic | en |
dc.identifier.academiclevel | Academic | en |
local.title.maintitle | Effectiveness of Targeted Interventions on Treatment of Infants With Bronchiolitis | en |
local.relation.fundingsourcenote | The Center of Research Excellence for Pediatric Emergency Medicine, Australia. This study was supported by the Victorian Government's Operational Infrastructure Support Program, Australia, and the Health Research Council of New Zealand (13/556). Partially funded by a Clinical Research Training Fellowship from the Health Research Council of New Zealand (19/140). Partially supported by Cure Kids, New Zealand. Partially funded by a grant from the Royal Children’s Hospital Foundation, Melbourne, Australia, and the National Health and Medical Research Council Practitioner Fellowship. | en |
local.output.categorydescription | C1 Refereed Article in a Scholarly Journal | en |
local.relation.grantdescription | NHMRC/1058560 | en |
local.search.author | Haskell, Libby | en |
local.search.author | Tavender, Emma J | en |
local.search.author | Wilson, Catherine L | en |
local.search.author | O'Brien, Sharon | en |
local.search.author | Babl, Franz E | en |
local.search.author | Borland, Meredith L | en |
local.search.author | Cotterell, Elizabeth | en |
local.search.author | Schembri, Rachel | en |
local.search.author | Orsini, Francesca | en |
local.search.author | Sheridan, Nicolette | en |
local.search.author | Johnson, David W | en |
local.search.author | Oakley, Ed | en |
local.search.author | Dalziel, Stuart R | en |
local.open.fileurl | https://rune.une.edu.au/web/retrieve/8ae3e50b-bb33-447a-98a4-a994628f76a2 | en |
local.uneassociation | Yes | en |
local.atsiresearch | No | en |
local.sensitive.cultural | No | en |
local.year.available | 2021 | en |
local.year.published | 2021 | en |
local.fileurl.open | https://rune.une.edu.au/web/retrieve/8ae3e50b-bb33-447a-98a4-a994628f76a2 | en |
local.fileurl.openpublished | https://rune.une.edu.au/web/retrieve/8ae3e50b-bb33-447a-98a4-a994628f76a2 | en |
local.subject.for2020 | 4203 Health services and systems | en |
local.profile.affiliationtype | External Affiliation | en |
local.profile.affiliationtype | External Affiliation | en |
local.profile.affiliationtype | External Affiliation | en |
local.profile.affiliationtype | External Affiliation | en |
local.profile.affiliationtype | External Affiliation | en |
local.profile.affiliationtype | External Affiliation | en |
local.profile.affiliationtype | UNE Affiliation | en |
local.profile.affiliationtype | External Affiliation | en |
local.profile.affiliationtype | External Affiliation | en |
local.profile.affiliationtype | External Affiliation | en |
local.profile.affiliationtype | External Affiliation | en |
local.profile.affiliationtype | External Affiliation | en |
local.profile.affiliationtype | External Affiliation | en |
local.date.moved | 2024-04-24 | en |
Appears in Collections: | Journal Article School of Rural Medicine |
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openpublished/EffectivenessCotterell2021JournalArticle.pdf | Published Version | 287.68 kB | Adobe PDF Download Adobe | View/Open |
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