Scholarlink

<p>This study aimed to describe the implementation and functioning of a regional hub-and-spoke model (“Gaslini Diffuso”) for managing pediatric bronchiolitis in Liguria, Italy, during the 2023–2024 season, focusing on severity stratification, resource allocation, and outcomes. A retrospective observational study was conducted across one tertiary hub (IRCCS Istituto Giannina Gaslini, Genoa) and four affiliated spoke hospitals. Medical records of all patients aged 0–2&#xa0;years hospitalized with bronchiolitis (ICD-9-CM 466.19) between October 2023 and March 2024 were reviewed. Demographic, clinical, microbiological, and treatment data were analyzed. Predictors of centralization to the hub were identified through multivariable logistic regression. A total of 562 patients were included (median age 95&#xa0;days; 40.4% female). Most cases were mild to moderate, with 56.6% requiring respiratory support—mainly low-flow oxygen or HFNC—and only 2% requiring mechanical ventilation. Thirteen patients (2.3%) were admitted to the PICU, and no deaths occurred. Centralized patients (<i>n</i> = 10) were significantly younger (median 43.5&#xa0;days) and had higher severity indicators, including elevated CO₂ and CRP levels, and longer respiratory support (median 5 vs. 3–4&#xa0;days, <i>p</i> &lt; 0.001). Independent risk factors for centralization were age &lt; 60&#xa0;days (OR 23.1, <i>p</i> = 0.004) and HFNC use (OR 20.5, <i>p</i> = 0.006). Spoke centers showed homogeneous adherence to referral criteria, though some variability in ancillary treatments persisted.</p><p> <i>Conclusions</i>:&#xa0;The Ligurian hub-and-spoke model demonstrated internal consistency between referral criteria and observed patient severity, supporting appropriate case stratification within the regional network. This integrated framework enhanced regional coordination and represents a scalable, sustainable model for pediatric respiratory disease management. <Table Float="No" ID="Taba"> <tgroup cols="1"> <colspec align="left" colname="c1" colnum="1" /> <tbody> <row> <entry align="left" colname="c1"> <p><b>What is Known:</b></p> <p>• <i>Bronchiolitis is the leading cause of hospitalization in infants under two, with seasonal surges that may overwhelm pediatric services; management remains largely supportive.</i></p> <p>• <i>Hub-and-spoke models have been proposed to optimize care and resource allocation, but real-world data on their clinical and organizational impact, especially post-COVID, is limited.</i></p> </entry> </row> <row> <entry align="left" colname="c1"> <p><b>What is New:</b></p> <p>• <i>This study evaluates, for the first time in Italy, the real-world implementation of a regional hub-and-spoke model (Gaslini Diffuso) for bronchiolitis management.</i></p> <p>• <i>The model enabled effective stratification of disease severity, with high specificity in centralizing only the most critical cases, ensuring efficient use of pediatric intensive care resources.</i></p> </entry> </row> </tbody> </tgroup> </Table></p>

错误：搜索内容不能为空，请输入英文关键词
错误：关键词超出字数限制，请精简
高级检索

Optimizing pediatric bronchiolitis management through an integrated hub-and-spoke network: evidence from a regional Italian experience

  • 期刊论文

  • 发表日期：

    2026年2月16日

查看全文
  • Marina Francesca Strati,
  • Marcello Mariani,
  • Giacomo Brisca,
  • Silvia Buratti,
  • Marta Ferretti,
  • Alberto Gaiero,
  • Valeria Musso,
  • Andrea Gazzolo,
  • Francesca Ginocchio,
  • Katiuscia Zerbini,
  • Diego Minghetti,
  • Maria Franca Corona,
  • Laura De Hoffer,
  • Daniela Pirlo,
  • Emanuela Piccotti,
  • Elio Castagnola,
  • Luca Antonio Ramenghi,
  • Giuseppe Spiga,
  • Marisa Alberti,
  • Raffaele Spiazzi,
  • Renato Botti,
  • Andrea Moscatelli

摘要

This study aimed to describe the implementation and functioning of a regional hub-and-spoke model (“Gaslini Diffuso”) for managing pediatric bronchiolitis in Liguria, Italy, during the 2023–2024 season, focusing on severity stratification, resource allocation, and outcomes. A retrospective observational study was conducted across one tertiary hub (IRCCS Istituto Giannina Gaslini, Genoa) and four affiliated spoke hospitals. Medical records of all patients aged 0–2 years hospitalized with bronchiolitis (ICD-9-CM 466.19) between October 2023 and March 2024 were reviewed. Demographic, clinical, microbiological, and treatment data were analyzed. Predictors of centralization to the hub were identified through multivariable logistic regression. A total of 562 patients were included (median age 95 days; 40.4% female). Most cases were mild to moderate, with 56.6% requiring respiratory support—mainly low-flow oxygen or HFNC—and only 2% requiring mechanical ventilation. Thirteen patients (2.3%) were admitted to the PICU, and no deaths occurred. Centralized patients (n = 10) were significantly younger (median 43.5 days) and had higher severity indicators, including elevated CO₂ and CRP levels, and longer respiratory support (median 5 vs. 3–4 days, p < 0.001). Independent risk factors for centralization were age < 60 days (OR 23.1, p = 0.004) and HFNC use (OR 20.5, p = 0.006). Spoke centers showed homogeneous adherence to referral criteria, though some variability in ancillary treatments persisted.

Conclusions: The Ligurian hub-and-spoke model demonstrated internal consistency between referral criteria and observed patient severity, supporting appropriate case stratification within the regional network. This integrated framework enhanced regional coordination and represents a scalable, sustainable model for pediatric respiratory disease management.

What is Known:

• Bronchiolitis is the leading cause of hospitalization in infants under two, with seasonal surges that may overwhelm pediatric services; management remains largely supportive.

• Hub-and-spoke models have been proposed to optimize care and resource allocation, but real-world data on their clinical and organizational impact, especially post-COVID, is limited.

What is New:

• This study evaluates, for the first time in Italy, the real-world implementation of a regional hub-and-spoke model (Gaslini Diffuso) for bronchiolitis management.

• The model enabled effective stratification of disease severity, with high specificity in centralizing only the most critical cases, ensuring efficient use of pediatric intensive care resources.