Objectives: Hospitalists are a new subgroup of pediatricians. However, data comparing quality of care between hospitalists and nonhospitalists are limited. Bronchiolitis, a common cause of pediatric hospital admission, is an appropriate condition for evaluating inpatient quality of care. The goal of this study was to identify quality indicators for the evaluation and treatment of children hospitalized with bronchiolitis based on the 2006 American Academy of Pediatrics guidelines and to assess differences in adherence rates to these indicators between hospitalist and nonhospitalist pediatricians.
Methods: This was a retrospective chart review of children admitted to 2 academic centers in 2007 and 2008. Reviewers selected charts with a discharge diagnosis of bronchiolitis and collected data on evaluation, treatment, length of stay, readmission, and adverse outcomes.
Results: Reviewers analyzed 713 charts. In children without objective response to bronchodilator therapy, hospitalists and nonhospitalists discontinued albuterol and racemic epinephrine similarly. Hospitalists discontinued unnecessary systemic corticosteroid therapy (75.0% vs 42.4%; P= .001) and antibiotic therapy (71.0% vs 48.6%; P= .007) more frequently than nonhospitalists.
Conclusions: These data suggest hospitalists better adhere to selected portions of the American Academy of Pediatrics bronchiolitis guidelines, thus providing higher quality of care. Quality indicators used in this study can distinguish physician performance in the inpatient management of bronchiolitis.