• J Hosp Med · Feb 2020

    Observational Study

    Impact of the Choosing Wisely® Campaign Recommendations for Hospitalized Children on Clinical Practice: Trends from 2008 to 2017.

    • Mario A Reyes, Veronica Etinger, Matt Hall, Daria Salyakina, Weize Wang, Luan Garcia, and Ricardo Quinonez.
    • Department of Pediatrics, Division of Hospital Medicine, Nicklaus Children's Hospital, Miami, Florida.
    • J Hosp Med. 2020 Feb 1; 15 (2): 68-74.

    BackgroundThe Choosing Wisely® Campaign (CWC) was launched in 2012. Five recommendations to reduce the use of "low-value" services in hospitalized children were published in 2013.ObjectivesThe aim of this study was to estimate the frequency and trends of utilization of these services in tertiary children's hospitals five years before and after the publication of the recommendations.MethodsWe conducted a retrospective, longitudinal analysis of hospitalizations to 36 children's hospitals from 2008 to 2017. The "low-value" services included (1) chest radiograph (CXR) for asthma, (2) CXR for bronchiolitis, (3) relievers for bronchiolitis, (4) systemic steroids for lower respiratory tract infection (LRTI), and (5) acid suppressor therapy for uncomplicated gastroesophageal reflux (GER). We estimated the annual percentages of the use of these services after risk adjustment, followed by an interrupted time series (ITS) analysis to compare trends before and after the publication of the recommendations.ResultsThe absolute decreases in utilization were 36.6% in relievers and 31.5% in CXR for bronchiolitis, 24.1% in acid suppressors for GER, 20.8% in CXR for asthma, and 2.9% in steroids for LRTI. Trend analysis showed that one "low-value" service declined significantly immediately (use of CXR for asthma), and another decreased significantly over time (relievers for bronchiolitis) after the CWC.ConclusionsThere was some decrease in the utilization of "low-value" services from 2008 to 2017. Limited changes in trends occurred after the publication of the recommendations. These findings suggest a limited impact of the CWC on clinical practice in these areas. Additional interventions are required for a more effective dissemination of the CWC recommendations for hospitalized children.

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