Low-value Care, and Variation in Practice for Children Hospitalized With Bronchiolitis
(CareBEST Trial)
Trial Summary
What is the purpose of this trial?
Low-value care is defined as the use of a health service, such as diagnostics and treatments, for which the harms or costs outweigh the benefits. In pediatrics, investigations or treatments can be unpleasant or traumatizing to the child, can prolong the time spent in hospital, and can create a cascade of further futile investigations and treatments. Several of the commonly used diagnostics and treatments in bronchiolitis are considered low-value, making it a great model to study low-value care in pediatrics. The purpose of CareBEST is to study the use of 6 low-value healthcare services in children aged 1 to 12 months hospitalized with bronchiolitis, their costs, and measure the variability in practice of these services. The main questions this study aims to answer are: 1. How frequently are 6 low-value care health services used in children hospitalized with bronchiolitis? These 6 low-value care health services are: 1) respiratory virus testing; 2) chest x-rays; 3) continuous pulse oximetry; 4) short-acting beta-agonists; 5) systemic corticosteroids; and 6) antibiotics. * Are there factors that predict the use of these services? * What are the costs of the use of these services? 2. How much variability is there between different patients, different doctors, and between hospitals in the use of these 6 low-value health services ? 3. Are differences in use of low-value health services associated with patient and family characteristics (like race and ethnicity, socioeconomic status, language), and do these contribute to disparities in care? Participants will have their infant's medical chart reviewed during their hospitalization. They will also have 2 short questionnaires to complete, once during their child's admission to the hospital, and one 30 days later to ask about whether their child required any additional medical care. They will additionally be asked to complete a questionnaire on their perceptions regarding their child's care while hospitalized, including the use of shared-decision making and their understanding of and involvement in the care decisions made. This analysis will provide a better understanding of treatment of bronchiolitis in Canada and help in the development of effective interventions to reduce low-value care.
Research Team
Olivier Drouin, MD, MSc, MPH
Principal Investigator
CHU Sainte-Justine Research Centre
Eligibility Criteria
Inclusion Criteria
Treatment Details
Find a Clinic Near You
Who Is Running the Clinical Trial?
St. Justine's Hospital
Lead Sponsor
Dr. Marc Girard
St. Justine's Hospital
Chief Medical Officer since 2018
MD from Université de Montréal
Dr. Fabrice Brunet
St. Justine's Hospital
Chief Executive Officer since 2009
Medical studies at Faculty of Medicine Cochin Port Royal, University of Paris V; Management studies at Paris Business School, Harvard Public Health School of Management, and University of Toronto
Maternal Infant Child and Youth Research Network
Collaborator
The Hospital for Sick Children
Collaborator
Dr. Ronald D. Cohn
The Hospital for Sick Children
Chief Executive Officer since 2019
MD from University of Düsseldorf, Germany
Dr. Lennox Huang
The Hospital for Sick Children
Chief Medical Officer since 2016
MD from McGill University
Children's Hospital of Eastern Ontario
Collaborator
Dr. Vera Etches
Children's Hospital of Eastern Ontario
Chief Executive Officer
MD from the University of Western Ontario
Dr. Carrol Pitters
Children's Hospital of Eastern Ontario
Chief Medical Officer since 2010
MD from the University of the West Indies
Unity Health Toronto
Collaborator
Dr. Sharon Straus
Unity Health Toronto
Chief Medical Officer
MD and MSc in Clinical Epidemiology, University of Toronto
Altaf Stationwala
Unity Health Toronto
Chief Executive Officer
Bachelor's degree in Health Administration, University of Ottawa