Background

Clinical practice guidelines for bronchiolitis recommend against tests and treatments that do not improve outcomes, yet most children admitted with bronchiolitis continue to receive them. An improved understanding of factors that influence care decisions across multiple stakeholders and diverse settings is needed to develop effective strategies to de-implement (or reduce) unnecessary testing and treatment.

Methods

We explored health care provider, care team, and parent perspectives on testing and treatment in bronchiolitis to develop a combined stakeholder account of care decisions. We conducted a qualitative case study across 2 geographically distinct university affiliated children's hospitals representing a generally low and high test/treatment utilizing hospital respectively from March 2019 to May 2020. We conducted 46 semistructured interviews and 3 focus groups with a total of 74 participants. Data were analyzed using applied thematic analysis and findings were triangulated across participant group and data collection method.

Results

Three themes emerged around care decisions: 1) awareness and perceptions of the guidelines or evidence; 2) perceptions of expected tests or treatments, and 3) organizational culture and existing care processes. Provider and care team participants commonly described parent expectations as drivers of utilization. Conversely, parents generally reported a lack of expectations for tests/treatments and that tests/treatments did not improve their experience of care.

Conclusions

This study illuminated factors associated with the differential adoption of evidence and targets for future de-implementation strategies. Importantly, incongruent with provider and care team perceptions, parents reported that they desire an evidence-based, less-is-more approach to bronchiolitis care.

中文翻译：

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该指南适用吗？——旨在了解毛细支气管炎护理决策的多地点联合利益相关者定性案例研究

背景

细支气管炎的临床实践指南建议不要进行不能改善结果的检查和治疗，但大多数因细支气管炎入院的儿童仍继续接受这些检查和治疗。需要更好地了解影响多个利益相关者和不同环境的护理决策的因素，以制定有效的策略来取消（或减少）不必要的检测和治疗。

方法

我们探讨了医疗保健提供者、护理团队和家长对毛细支气管炎检测和治疗的看法，以制定护理决策的综合利益相关者账户。2019 年 3 月至 2020 年 5 月，我们对 2 家地理位置不同的大学附属儿童医院进行了一项定性案例研究，这两家医院分别代表测试/治疗利用率普遍较低和较高的医院。我们进行了 46 次半结构化访谈和 3 个焦点小组，共有 74 名参与者。使用应用主题分析对数据进行分析，并根据参与者组和数据收集方法对结果进行三角测量。

结果

围绕护理决策出现了三个主题：1）对指南或证据的认识和看法；2) 对预期测试或治疗的看法，以及 3) 组织文化和现有护理流程。提供者和护理团队参与者通常将家长的期望描述为利用的驱动因素。相反，父母普遍报告对检查/治疗缺乏期望，并且检查/治疗并没有改善他们的护理体验。

结论

这项研究阐明了与未来取消实施策略的证据和目标的差异采用相关的因素。重要的是，与提供者和护理团队的看法不一致的是，家长们报告说，他们希望采用一种循证、少即是多的方法来治疗细支气管炎。