1930. Utilizing Claims Data to Identify Stewardship Targets in Pediatrics
Session: Poster Abstract Session: Antibiotic Stewardship: Pediatrics
Saturday, October 29, 2016
Room: Poster Hall
  • IDWeek 2016 Poster - Claims Data_v3 final.pdf (1.0 MB)
  • Background: Claims data have not been widely used to target stewardship efforts. Partners for Kids (PFK) is an accountable care organization that accepts financial responsibility for Medicaid managed care children in a 34 county region of Central/Southeast Ohio.

    Methods: We assessed antibiotic prescriptions dispensed by retail pharmacies in 2014 to PFK members aged 0-18 years. First, data was evaluated by patient age and county of residence. Prescription rates were reported as the number per thousand member-months (P/TMM), where each member-month was one month of PFK membership for a unique patient. Next, antibiotic prescriptions temporally associated (within 3 days) with upper respiratory infection (URI) and sinusitis diagnoses were measured by county of residence. Finally, in order to assess appropriate antibiotic prescribing for uncomplicated patients, we excluded children with 1) previous encounters in the prior 30 days, 2) antibiotic prescriptions in the prior 30 days, and 3) chronic or complex medical conditions. After these exclusions, we assessed antibiotic prescriptions associated with URI and/or sinusitis diagnoses.

    Results: Of 254,835 antibiotic prescriptions dispensed to PFK members, >25% were dispensed to children aged <3 years and >50% to children aged <7 years. Among the 34 counties, prescription rates ranged from 44.2 to 129.0 P/TMM, with highest rates in rural Southeast Ohio. URI-associated antibiotics ranged from 2.4 to 14.6 P/TMM, and sinusitis-associated antibiotics ranged from 2.2 to 24.6 P/TMM. County sinusitis-associated antibiotic rates correlated positively with azithromycin prescription rates (r=0.76, P<.0001, Spearman correlation). Among uncomplicated patients prescribed an antibiotic associated with a medical encounter, URI and/or sinusitis (without a concomitant bacterial diagnosis) accounted for 17.8% of total prescriptions. Azithromycin accounted for 23.2% of sinusitis-associated prescriptions and was the 2nd most common antibiotic for sinusitis, after amoxicillin.

    Conclusion: Claims data can be used to identify targets for antimicrobial stewardship. Efforts to reduce prescriptions should focus on young children, those in rural counties, and those with a URI/sinusitis diagnosis.

    Joshua Watson, MD1, Ling Wang, PhD, MPH2 and Preeti Jaggi, MD1, (1)Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University, Columbus, OH, (2)Nationwide Children's Hospital, Columbus, OH


    J. Watson, None

    L. Wang, None

    P. Jaggi, None

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