Treatment of bronchopulmonary dysplasia differs dramatically among institutions. But why does variation matter?
Recent studies report extreme variation among hospitals ordering three common medications for chronic lung disease, or bronchopulmonary dysplasia, calling into question the appropriateness of their use and the reason for their prescription.
“In the use of diuretics, inhaled bronchodilators and inhaled corticosteroids, there’s profound variation. The institution that babies are admitted to appears to have far more to do with what drugs they’re given than how sick they are,” says Jonathan L. Slaughter, MD, MPH, a neonatologist and principal investigator in the Center for Perinatal Research in The Research Institute at Nationwide Children’s Hospital. “The national picture shows that we, as neonatologists, don’t actually know what to do with these drugs.”
In 2013, Dr. Slaughter published a study in Pediatrics reporting diuretics were ordered for anywhere from 4 to 86 percent of BPD patients, depending on the hospital. His work published in PLoS One and the Journal of Perinatology in the next two years revealed similarly striking variations in prescriptions for corticosteroids and bronchodilators.
The inconsistencies may be due to a lack of evidence that these three medications improve long-term outcomes in infants with BPD, Dr. Slaughter theorizes. “There is a lot of research to discover new drugs, but not to evaluate the effectiveness of drugs we’re already giving.”
This knowledge gap undoubtedly affects patient health as well. At best, Dr. Slaughter explains, patients are either not receiving a drug that could help or are receiving ineffective drugs. At worst, they’re experiencing harmful side effects and footing the bill for inappropriate treatments.
“We really need to take a hard look at what we’re doing as a group and determine whether it’s evidence-based or just based on tradition,” says Dr. Slaughter, who is co-leading a brainstorming workshop on standardization and practice variation in pediatrics at the 2015 Pediatric Academic Societies annual meeting.
He advocates for comparative effectiveness studies of existing treatments and changes to standardized algorithms used in clinical practice to improve therapies in neonatology practice.
“Therapies that are well supported by evidence are used similarly across the board,” Dr. Slaughter says. “The degree of variation in BPD treatments shows the neonatal community that we have a problem we need to solve.”
Join the conversation. Does your institution have specific guidelines for BPD prescriptions? If so, how were they developed?