Objectives were to develop metrics to improve understanding of antimicrobial prescribing among ambulatory clinicians and to demonstrate improvement in guideline-appropriate use of antimicrobials for acute respiratory tract infections in pediatric patients.
Methods: Three measures for antibiotic utilization were created, and patterns of use were evaluated by clinician type, clinic site, and primary care specialty. Baseline performance scores for acute upper respiratory infection (URI), acute sinusitis (AS), and acute otitis media (AOM) were determined between January and June 2014. Ten clinics with scores < 80% for two of the three metrics were included in an intervention collaborative that included initial on-site guideline and coding education, electronic audit, and clinician-specific feedback. In December 2014, URI was designated a non-productivity incentive compensation metric for all pediatricians.
Results: For the first three months of 2015, pediatricians ordered between 278 and 317 antibiotic prescriptions per 1,000 illness encounters, compared with 189-223 for family medicine and 147-176 for internal medicine physicians. Among pediatric, family medicine, and internal medicine physicians, rates of antibiotic prescribing per physician were 60, 56, and 38, but broad spectrum antibiotic percentages were 52, 66, and 71, respectively.
Performance improvement for the intervention collaborative was most striking with acute URI with improvement from 76% in January 2014 to 96% in March 2015. All other pediatric clinics (n=14) remained at 94-96% throughout the measurement period, and all family medicine clinics (n=84) varied between 57-71%. The collaborative improved from 36% to 84% for AS and 37% to 61% for AOM while performance for the two comparison groups remained stable.
Conclusion: Highest rates of antibiotic prescribing per physician and per 1,000 illness encounters but lowest broad spectrum antibiotic prescribing rates were found among pediatricians. Education, audit and feedback improved guideline-appropriate antimicrobial prescribing for three common acute upper respiratory tract infections in children. A financial incentive can drive even higher performance for acute URI.
H. Clegg II,
R. Bean, None
L. Blanchette, None
A. Hoth, None