1601. Impact of Personalized Audit and Feedback on Management of Pediatric Outpatient Community-Acquired Pneumonia
Session: Poster Abstract Session: Stewardship: Pediatric Antimicrobial Stewardship
Friday, October 6, 2017
Room: Poster Hall CD
  • IDWeek Poster_Handy_1601.pdf (1.3 MB)
  • Background: 

    Community-acquired pneumonia (CAP) is a common infection in children. Guidelines recommend amoxicillin as first line therapy for CAP, while macrolides are recommended for school-aged children with atypical pneumonia. Despite guidelines, antibiotic choice for CAP varies widely among providers. We aimed to determine the impact of outpatient audit and feedback to individual providers on adherence with published guidelines. 


    We conducted a randomized controlled trial of primary care clinicians in a multi-state primary care network from 8/2016-2/2017.  Providers received baseline education. The intervention included personalized feedback from investigators at 1-month intervals on the provider’s management of a case of CAP identified by ICD-10-CM codes. Prescription counts of guideline-recommended antibiotic therapy were compared between groups by Pearson’s chi-squared. Performance scores incorporating diagnostic and treatment decisions such as physical examination elements, antibiotics and medication dosing appropriate for a CAP encounter as defined by clinical practice guidelines were calculated for each encounter during study intervals.    


    Among the 43 providers, the majority were physicians (76% control, 86% intervention).  There were no significant differences in work hours, years since board certification, sex or race between groups. 316 distinct cases of CAP were diagnosed (214 control; 102 intervention). In patients <5 years, there was no significant difference in prescription of amoxicillin between groups (61/103 (59.2%) control; 23/48 (47.9%) intervention, p=0.19).  In patients ≥5 years, there was a significant difference in prescription of guideline recommended antibiotics of amoxicillin or azithromycin (81/103 (78.6%) control; 48/51 (94.1%) intervention, p<0.05). There was a small, but apparent upward trend in mean performance scores in the intervention group (Figure 1).


    Personalized, scheduled audit and feedback in the outpatient setting had a small but measurable impact on improving physician adherence with guidelines. Audit and feedback alone is insufficient to substantially improve guideline adherence in the management of CAP and should be combined with other antimicrobial stewardship interventions.  


    Lori Handy, MD, MSCE1,2, Adriana Cadilla, MD3, Lloyd Werk, MD, MPH4, Maria Carmen Diaz, MD5, James Franciosi, MD, MSCE6, Joanne Dent, RN, MS, PMP7, Jobayer Hossain, PhD7, James Crutchfield Jr., PhD8 and Timothy Wysocki, PhD9, (1)Division of Infectious Diseases, The Children's Hospital of Philadelphia, Philadelphia, PA, (2)Division of Infectious Diseases, Nemours/A.I. duPont Hospital for Children, Wilmington, DE, (3)Division of Infectious Diseases, Nemours Children's Hospital, Orlando, FL, (4)Department of Pediatrics, Nemours Children's Hospital, Orlando, FL, (5)Division of Emergency Medicine, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, (6)Division of Gastroenterology, Nemours Children's Hospital, Orlando, FL, (7)Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, (8)Lockheed Martin Rotary and Mission Systems, Orlando, FL, (9)Nemours Children's Health System, Jacksonville, FL


    L. Handy, None

    A. Cadilla, None

    L. Werk, None

    M. C. Diaz, None

    J. Franciosi, None

    J. Dent, None

    J. Hossain, None

    J. Crutchfield Jr., None

    T. Wysocki, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 4th with the exception of research findings presented at the IDWeek press conferences.