Details:

Alternative Title:
Infect Control Hosp Epidemiol
Personal Author:
Madaras-Kelly, Karl J. ; Rovelsky, Suzette A. ; McKie, Robert A. ; Nevers, McKenna R. ; Ying, Jian ; ... More +
Madaras-Kelly, Karl J. ; Rovelsky, Suzette A. ; McKie, Robert A. ; Nevers, McKenna R. ; Ying, Jian ; Haaland, Benjamin A. ; Kay, Chad L. ; Christopher, Melissa L. ; Hicks, Lauri A. ; Samore, Mathew H. Less -
Description:
Objective:

To determine whether a clinician-directed acute respiratory tract infection (ARI) intervention was associated with improved antibiotic prescribing and patient outcomes across a large US healthcare system.

Design:

Multicenter retrospective quasi-experimental analysis of outpatient visits with a diagnosis of uncomplicated ARI over a 7-year period.

Participants:

Outpatients with ARI diagnoses: sinusitis, pharyngitis, bronchitis, and unspecified upper respiratory tract infection (URI-NOS). Outpatients with concurrent infection or select comorbid conditions were excluded.

Intervention(s):

Audit and feedback with peer comparison of antibiotic prescribing rates and academic detailing of clinicians with frequent ARI visits. Antimicrobial stewards and academic detailing personnel delivered the intervention; facility and clinician participation were voluntary.

Measure(s):

We calculated the probability to receive antibiotics for an ARI before and after implementation. Secondary outcomes included probability for a return clinic visits or infection-related hospitalization, before and after implementation. Intervention effects were assessed with logistic generalized estimating equation models. Facility participation was tracked, and results were stratified by quartile of facility intervention intensity.

Results:

We reviewed 1,003,509 and 323,023 uncomplicated ARI visits before and after the implementation of the intervention, respectively. The probability to receive antibiotics for ARI decreased after implementation (odds ratio [OR], 0.82; 95% confidence interval [CI], 0.78–0.86). Facilities with the highest quartile of intervention intensity demonstrated larger reductions in antibiotic prescribing (OR, 0.69; 95% CI, 0.59–0.80) compared to nonparticipating facilities (OR, 0.89; 95% CI, 0.73–1.09). Return visits (OR, 1.00; 95% CI, 0.94–1.07) and infection-related hospitalizations (OR, 1.21; 95% CI, 0.92–1.59) were not different before and after implementation within facilities that performed intensive implementation.

Conclusions:

Implementation of a nationwide ARI management intervention (ie, audit and feedback with academic detailing) was associated with improved ARI management in an intervention intensity–dependent manner. No impact on ARI-related clinical outcomes was observed.


Keywords:
[+]
Anti-Bacterial Agents Humans Multicenter Studies As Topic Practice Patterns, Physicians' Respiratory Tract Infections Retrospective Studies Veterans
Source:
Infect Control Hosp Epidemiol. 44(5):746-754
Pubmed ID:
35968847
Pubmed Central ID:
PMC10882581
Document Type:
Journal Article
Funding:
CC999999/ImCDC/Intramural CDC HHSUnited States/
Collection(s):
CDC Public Access
Main Document Checksum:
[+]
urn:sha256:0c5f58762d631b47bc1f58e4c515367f31e246ea97337ad73fe97572a6c583ab
Download URL:
https://stacks.cdc.gov/view/cdc/150315/cdc_150315_DS1.pdf
File Type:

Supporting Files

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  	NIHMS1965860-supplement-supplementary_material.docx	docx

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