Low‐value care and variation in practice in the care of children hospitalized with bronchiolitis in Canada (CareBEST): Protocol for a multi‐center prospective cohort study

INTRODUCTION: Low-value care refers to health services for which the potential harms or costs outweigh the benefits of use. Bronchiolitis is the most common and among the most costly causes of pediatric hospitalizations. Evidence consistently shows that many common tests and treatments used to manage bronchiolitis do not improve outcomes. Further, differential use of low-value care between patients may perpetuate care inequities. In Canada, rates of low-value care use in children hospitalized with bronchiolitis, and differences in care across hospitals, clinicians, and patient subgroups, remain poorly characterized. OBJECTIVE: To understand practice patterns for six low-value health services in the care of children aged 1-12 months hospitalized for bronchiolitis: respiratory virus testing; chest X-rays; continuous pulse oximetry; short-acting beta-agonists; systemic corticosteroids; and antibiotics. METHODS: We are conducting a multi-center prospective cohort study of children admitted with bronchiolitis in 15 Canadian hospitals. We will use chart reviews to compare low-value care use between hospitals and clinicians, and caregiver surveys to compare between sociodemographic groups. Questionnaires will also collect caregiver perspectives on their child's bronchiolitis care, including role in medical decision-making and understanding of treatment decisions. DISCUSSION: Our study will provide critical information on the usage and variation in delivery of low-value care for bronchiolitis in Canada, elucidating potential care inequities. Findings will inform the development of interventions to address such inequities, and improve opportunity costs for health systems. Enrollment began in October 2024 and is projected to be completed in May 2026, with analyses and reporting shortly following.