{
  "abstract": "Background In 2017, the PREDICT (Paediatric Research in Emergency Departments International Collaborative) network conducted a cluster randomised controlled trial (cRCT) at 26 Australian and New Zealand hospitals to improve bronchiolitis care. Findings demonstrated that targeted interventions significantly improved adherence with five evidence-based low-value bronchiolitis practices (no chest radiography, salbutamol, glucocorticoids, antibiotics and epinephrine) in the first 24 hours of hospitalisation (adjusted risk difference, 14.1%; 95% CI: 6.5% to 21.7%; p<0.001). During the intervention year (2017), intervention hospital (n=13) compliance was 85.1% (95% CI: 82.6% to 89.7%). This study aimed to determine if improvements in bronchiolitis management were sustained at intervention hospitals 2 years post-trial completion.Methods International, multicentre follow-up study of hospitals in Australia and New Zealand that participated in a cRCT of de-implementation of low-value bronchiolitis practices, 1 year (2018) and 2 years (2019) post-trial completion, obtained retrospectively from medical audits. Sustainability was defined a priori as no more than a <7% decrease to any level of improvement in adherence for all five low-value practices (composite outcome) from the cRCT intervention year.Results Of the 26 hospitals, 11 intervention and 10 control hospitals agreed to participate in the follow-up study. Data were collected on 3299 infants with bronchiolitis 1 year (intervention and control hospitals) and 1689 infants 2 years post-trial (intervention hospitals). Adherence with no use of the five low-value practices 2 years post-trial completion was 80.9% (adjusted predicted adherence, 80.8%, 95% CI: 77.4% to 84.2%; estimated risk difference from cRCT outcome −3.9%, 95% CI: −8.6% to 0.8%) at intervention hospitals, fulfilling the a priori definition of sustainability.Discussion Targeted interventions, delivered over one bronchiolitis season, resulted in sustained improvements in bronchiolitis management in infants 2 years later. This follow-up study provides evidence for sustainability in de-implementing low-value care in bronchiolitis management.Trial registration details Australian and New Zealand Clinical Trials Registry No: ACTRN12621001287820.",
  "authors": [
    {
      "affiliations": [
        "Nursing Research Institute, St Vincent’s Health Network Sydney, Australia",
        "St Vincent’s Hospital Melbourne, Australian Catholic University, Darlinghurst, New South Wales, Australia",
        "School of Nursing, Midwifery and Paramedicine, Australian Catholic University - North Sydney Campus, North Sydney, New South Wales, Australia"
      ],
      "name": "Victoria Ramsden"
    },
    {
      "affiliations": [
        "Clinical Sciences, Murdoch Childrens Research Institute, Parkville, Victoria, Australia",
        "Emergency Department, The Royal Children’s Hospital Melbourne, Parkville, Victoria, Australia",
        "Department of Paediatrics and Critical Care, The University of Melbourne - Parkville Campus, Melbourne, Victoria, Australia"
      ],
      "name": "Franz E Babl"
    },
    {
      "affiliations": [
        "Department of Paediatrics: Child and Youth Health, University of Auckland - City Campus, Grafton, Auckland, New Zealand",
        "Children’s Emergency Department, Starship Children’s Health, Grafton, Auckland, New Zealand"
      ],
      "name": "Libby Haskell"
    },
    {
      "affiliations": [
        "Clinical Sciences, Murdoch Childrens Research Institute, Parkville, Victoria, Australia"
      ],
      "name": "Catherine Wilson"
    },
    {
      "affiliations": [
        "Nursing Research Institute, St Vincent’s Health Network Sydney, Australia",
        "St Vincent’s Hospital Melbourne, Australian Catholic University, Darlinghurst, New South Wales, Australia",
        "School of Nursing, Midwifery and Paramedicine, Australian Catholic University - North Sydney Campus, North Sydney, New South Wales, Australia"
      ],
      "name": "Sandy Middleton"
    },
    {
      "affiliations": [
        "Clinical Epidemiology and Biostatistics Unit, Murdoch Children’s Research Institute, Parkville, Victoria, Australia"
      ],
      "name": "Rachel Schembri"
    },
    {
      "affiliations": [
        "Department of Emergency Medicine, Research, Toowoomba Hospital, Toowoomba, Queensland, Australia"
      ],
      "name": "Alex King"
    },
    {
      "affiliations": [
        "Department of Paediatrics: Child and Youth Health, University of Auckland - City Campus, Auckland, New Zealand",
        "Depatment of Paediatrics, Waikato Hospital, Hamilton, New Zealand"
      ],
      "name": "Alexandra Wallace"
    },
    {
      "affiliations": [
        "Emergency Department, Royal North Shore Hospital, St Leonards, New South Wales, Australia"
      ],
      "name": "Alison Partyka"
    },
    {
      "affiliations": [
        "Emergency Department, Sydney Children’s Hospital Randwick, Randwick, New South Wales, Australia"
      ],
      "name": "Casey Baldock"
    },
    {
      "affiliations": [
        "Department of Emergency Medicine, Townsville Hospital and Health Service, Townsville, Queensland, Australia"
      ],
      "name": "Julian Wong"
    },
    {
      "affiliations": [
        "Department of Paediatrics, Hawke’s Bay Hospital, Hastings, New Zealand"
      ],
      "name": "Kai Steinmann"
    },
    {
      "affiliations": [
        "Emergency Research, The Prince Charles Hospital, Chermside, Queensland, Australia"
      ],
      "name": "Louise Mills"
    },
    {
      "affiliations": [
        "Emergency Department, Queensland Children’s Hospital, South Brisbane, Queensland, Australia",
        "Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia"
      ],
      "name": "Natalie Phillips"
    },
    {
      "affiliations": [
        "Emergency Department, Grampians Health, Ballarat, Victoria, Australia",
        "Victorian Institute of Forensic Medicine, Southbank, Victoria, Australia"
      ],
      "name": "Nola Poulter"
    },
    {
      "affiliations": [
        "Department of Emergency Medicine, The Children’s Hospital at Westmead, Westmead, New South Wales, Australia",
        "Faculty of Medicine and Health, The University of Sydney - Camperdown and Darlington Campus, Sydney, New South Wales, Australia"
      ],
      "name": "Shefali Jani"
    },
    {
      "affiliations": [
        "Emergency Department, Caboolture Hospital, Caboolture, Queensland, Australia"
      ],
      "name": "Suzanne Kenny"
    },
    {
      "affiliations": [
        "Emergency Department, The Royal Children’s Hospital Melbourne, Parkville, Victoria, Australia",
        "Department of Paediatrics and Critical Care, The University of Melbourne - Parkville Campus, Melbourne, Victoria, Australia"
      ],
      "name": "Ed Oakley"
    },
    {
      "affiliations": [
        "Department of Paediatrics, Royal Darwin Hospital, Casuarina, Northern Territory, Australia"
      ],
      "name": "Anna Lithgow"
    },
    {
      "affiliations": [
        "Healthy Brain and Mind Research Centre, Australian Catholic University, Fitzroy, Victoria, Australia"
      ],
      "name": "Peter Wilson"
    },
    {
      "affiliations": [
        "Nursing Research Institute, St Vincent’s Health Network Sydney, Australia",
        "St Vincent’s Hospital Melbourne, Australian Catholic University, Darlinghurst, New South Wales, Australia",
        "School of Nursing, Midwifery and Paramedicine, Australian Catholic University - North Sydney Campus, North Sydney, New South Wales, Australia"
      ],
      "name": "Elizabeth McInnes"
    },
    {
      "affiliations": [
        "Department of Paediatrics: Child and Youth Health, University of Auckland - City Campus, Grafton, Auckland, New Zealand",
        "Children’s Emergency Department, Starship Children’s Health, Grafton, Auckland, New Zealand"
      ],
      "name": "Stuart Dalziel"
    },
    {
      "affiliations": [
        "Clinical Sciences, Murdoch Childrens Research Institute, Parkville, Victoria, Australia",
        "Department of Paediatrics and Critical Care, The University of Melbourne - Parkville Campus, Melbourne, Victoria, Australia"
      ],
      "name": "Emma Tavender"
    }
  ],
  "title": "Sustainability of the de-implementation of low-value care in infants with bronchiolitis: 2-year follow-up of a cluster randomised controlled trial",
  "uid": "be350c61-2e58-5a9a-8ac1-eba543e8beb9"
}