The Evolution of Quality Benchmarks for Bronchiolitis

BACKGROUND AND OBJECTIVES Evidence suggests that average performance on quality measures for bronchiolitis has been improving over time, but it is unknown whether optimal performance, as defined by Achievable Benchmarks of Care (ABCs), has also changed. Thus, we aimed to compare ABCs for established bronchiolitis quality measures between 2 consecutive time periods. As a secondary aim, we evaluated performance gaps, defined as the difference between median performance and ABCs, to identify measures that may benefit most from targeted quality initiatives. METHODS We used hospital administrative data from the Pediatric Health Information System database to calculate ABCs and performance gaps for nonrecommended bronchiolitis tests and treatments in 2 groups (patients discharged from the emergency department [ED] and those hospitalized) over 2 time periods (2006–2014 and 2014–2019) corresponding to publication of national bronchiolitis guidelines. RESULTS Substantial improvements were identified in ABCs for chest radiography (ED −8.8% [confidence interval (CI) −8.3% to −9.4%]; hospitalized −17.5% [CI −16.3% to −18.7%]), viral testing (hospitalized −14.6% [CI −13.5% to −15.7%]), antibiotic use (hospitalized −10.4% [CI −8.9% to −11.1%]), and bronchodilator use (ED −9.0% [CI −8.4% to −9.6%]). Viral testing (ED 11.5% [CI 10.9% to 12.1%]; hospitalized 21.5% [CI 19.6% to 23.4%]) and bronchodilator use (ED 13.8% [CI 12.8% to 14.8%]; hospitalized 22.8% [CI 20.6% to 25.1%]) demonstrated the largest performance gaps. CONCLUSIONS Marked changes in ABCs over time for some bronchiolitis quality measures highlight the need to reevaluate improvement targets as practice patterns evolve. Measures with large performance gaps, such as bronchodilator use and viral testing, are recommended as targets for ongoing quality improvement initiatives.