217. Bang for the Buck: Lessons Learned from An Ambulatory Stewardship Pilot to Reduce Excess Antibiotic Prescribing for Adult Upper Respiratory Infections
Session: Poster Abstract Session: Antimicrobial Stewardship: Interventions to Improve Outcomes
Thursday, October 4, 2018
Room: S Poster Hall
Background: Upper respiratory infections (URIs) are a source of unnecessary antibiotic use in the US1. To address antibiotic overuse in our clinics, we participated in a multi-phase stewardship collaborative established by the United Hospital Fund. We aimed to pilot stewardship policies for adult URIs at the Montefiore Medical Group (MMG) practices in Bronx, NY.

Methods: Phase 1: evaluation of provider use of ICD-10 codes for URIs generally not requiring antibiotics at target sites (TS) with random chart abstraction validation. Phase 2: implementation of stewardship interventions (Table 1). Prescribing patterns were evaluated using electronic health record data at the end of Phase 2 comparing TS (n=6; 2 resident clinics, 4 non-resident clinics) to the prior year and to non-target sites (NTS) (n=13).

Results: There were 6819 visits of interest from October 2017 to February 2018 within MMG. Top three codes utilized are shown in Figure 1. TS prescribing declined post-intervention and compared to NTS (Table 2). Non-resident TS participated in 4 interventions, and resident TS were involved in 2-3. Macrolides were the most utilized antibiotic class (Figure 2).

Conclusion: We attribute the decline in prescribing at TS to the collective impact of our stewardship activities. Stewardship team driven interventions had better uptake than provider-driven initiatives. We plan to continue activities with the highest uptake and feasibility. Long-term goals include development and integration of stewardship metrics into our outpatient quality structure.


1 Shapiro DJ, Hicks LA, Pavia AT, Hersh AL. Antibiotic prescribing for adults in ambulatory care in the USA, 2007-09. J Antimicrob Chemother. 2014;69(1):234-40

Table 1: Phase 2 interventions and uptake


Intended Clinic Uptake

Provider Lectures


Provider Report Card


Viral Prescription pad


Commitment Poster


Follow-up Phone Calls to Patients


Educational Email to Patients


In-office Video Session with Patients


Waiting Room Video


Table 2: Prescribing rates for top 3 URI ICD-10 codes

Antibiotics prescribed (%)


TS – Oct17-Feb18

435 (17%)


TS– Oct 16-Feb17

633 (25%)


NTS– Oct17-Feb18

736 (25%)


*comparing to Oct17-Feb18 TS; χ-square used

Jaimie Mittal, MD1, Kelsie Cowman, MPH1, Abel Infante, -2, Paul Meissner, MSPH2, Asif Ansari, MD3, Priya Nori, MD1 and Belinda Ostrowsky, MD, MPH, FIDSA, FSHEA1, (1)Division of Infectious Diseases, Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, (2)Department of Family and Social Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, (3)Montefiore Medical Group, Montefiore Medical Center, Bronx, NY


J. Mittal, None

K. Cowman, None

A. Infante, None

P. Meissner, None

A. Ansari, None

P. Nori, None

B. Ostrowsky, None

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