Development of a questionnaire to assess the impact on parents of their infant's bronchiolitis hospitalization.

BACKGROUND: Bronchiolitis is a distressing respiratory condition and the most common cause of hospitalization during the first year of life. The hospitalization of an infant is a stressful event for parents and deserves careful consideration. The objective of this work was to develop and validate a self-administered instrument that comprehensively assesses the impact on parents of the hospitalization of their infant for bronchiolitis. METHODS: The Impact of Bronchiolitis Hospitalization Questionnaire (IBHQ©) was developed using a literature review and pre-study interviews with both parents and clinicians. For finalization and psychometric validation, it was included in a multicenter, longitudinal, observational study conducted in France. Parents of infants under the age of 1 year and hospitalized for bronchiolitis were asked to complete the questionnaire at hospital discharge, and 3 months after. RESULTS: Seven hundred and seven questionnaires were completed by the parents of the 463 eligible infants. After finalization, based on principal component analyses, the IBHQ included 30 core items allowing the calculation of 7 dimension core scores (Worries and distress; Fear for future; Guilt; Impact on daily organization; Physical impact; Impact on behavior with hospitalized infant; Financial impact), as well as 16 optional items, allowing the calculation of 5 optional dimension scores (Disturbed breastfeeding; Physical reaction of hospitalized infant; Impact on feeding; Impact on behavior with other infants; Siblings' reaction). Internal consistency reliability and construct validity of the IBHQ were satisfactory. The highest impact was observed for "Worries and distress", "Fear for future" and "Impact on daily organization" scores. CONCLUSIONS: The IBHQ is a reliable and valid instrument for assessing the multifaceted impact on parents of the hospitalization of their infant for bronchiolitis.

Use of Social Psychology to Improve Adherence to National Bronchiolitis Guidelines.

OBJECTIVES: The American Academy of Pediatrics' bronchiolitis guidelines recommend against albuterol and corticosteroids for treating and chest radiographs (CRs) for diagnosing infants with bronchiolitis. However, high rates of nonadherence have been documented. Our objective was to improve guideline adherence in infants with bronchiolitis. METHODS: This quality improvement study was conducted in 1 urban academic pediatric primary care clinic caring for predominately minority and publicly insured children. We tested provider guideline education, display of guidelines in patient care areas, and monthly e-mails to all providers documenting deviation rates, with individual e-mails to providers who deviated. P-charts and interrupted time series analysis were used to estimate the effect of the intervention. RESULTS: There were 380 children <2 years of age with a diagnosis of bronchiolitis in the 16 nonsummer months preintervention and 417 in the 15 postintervention months. Rates of prescribed and administered albuterol declined from 45.7% in the baseline period to 13.7% in the intervention period and CR use dropped from a mean of 10.1% to 3.4%, both demonstrating special cause variation. Steroid use did not change significantly. In interrupted time series analyses, the intervention was associated with a significant decrease in albuterol use (P < .001) but not in CR or steroid use. Emergency department visits declined slightly but admissions for bronchiolitis were stable. CONCLUSIONS: Traditional quality improvement efforts coupled with social psychology techniques resulted in improved guideline adherence in outpatient bronchiolitis management. Additional study will help identify which techniques are most effective for increasing guideline adherence in cases of low-value care.

At-home recovery following hospitalization for bronchiolitis.

OBJECTIVES: To characterize the at-home recovery of infants after hospitalization for bronchiolitis, the impact of recovery from this illness on the family, and the association between delayed infant recovery and parental satisfaction with hospital care. METHODS: Otherwise healthy infants less than 1 year of age admitted to 6 children's hospitals were eligible. Telephone interviews with 486 parents (85% of sampled), 1-2 weeks following discharge, addressed functional recovery, lingering symptoms, family disruption, returns to the emergency department, and parental recall of satisfaction with care. RESULTS: Two thirds of infants experienced difficulties with normal routines (feeding, sleeping, contentedness, liveliness) on the day of discharge. By 5 days at home, 22% continued to experience disruption in sleeping, and 16% in feeding routines. Coughing (56%) and wheezing (27%) were common 4 to 6 days after discharge. Parents who reported longer delays in return to normal family routines took additional time off work, kept their infants out of day care twice as many days, and were more likely to take their infants to the doctor or hospital for repeat medical care. Parents from families slower to return to a normal routine recalled the hospital stay less favorably. CONCLUSIONS: A small but important proportion of infants have a protracted recovery period following hospitalization for bronchiolitis. Delayed recovery is associated with parental work time loss and less favorable parental impressions of care in the hospital. Anticipatory guidance about home recovery could allow parents to plan for extended home care and improve satisfaction with hospital care.