1813. Development and validation of novel ambulatory antibiotic stewardship metrics
Session: Poster Abstract Session: Antimicrobial Stewardship: New Methods and Metrics
Saturday, October 6, 2018
Room: S Poster Hall
Posters
  • Outpatient Poster 2018 v2.pdf (312.4 kB)
  • Background: Over 260 million antibiotic courses are prescribed in ambulatory settings per year in the United States: 41% of which are for acute respiratory tract infections (ARTI). Over 50% of these antibiotic courses are inappropriate. However, interventions to improve ambulatory prescribing are little studied, and metrics to track antibiotic use are not well validated.

    Methods: To validate metrics for ARTIs in adults, we conducted a retrospective cohort study from January 1, 2016 - December 31, 2016 at 32 primary care practices. We randomly selected 1200 office visits with a coded respiratory tract diagnosis and determined by medical record review the proportion of visits in which antibiotic prescription was inappropriate using modified Infectious Diseases Society of America treatment guidelines. We determined clinic and provider characteristics associated with inappropriate prescribing. By linear regression, we also determined the aggregate metrics best correlated with inappropriate antibiotic prescribing.

    Results: An antibiotic was prescribed in 37% of visits in which a respiratory tract diagnosis was coded. Of these prescriptions, 69% were inappropriate. Demographics associated with inappropriate prescribing included advance practice provider v. physician (72% v. 58%, p=0.02), family medicine v. internal medicine (75% v. 63%, p=0.01), board certification after v. before 1997 (75% v. 63%, p=0.02), and practice in a non-teaching v. teaching clinic (73% v. 51%, p<0.001). Rate of antibiotic prescribing in visits where any respiratory tract diagnosis was coded (R2=0.23, p<0.001) and rate of antibiotic prescribing in visits where a respiratory tract diagnosis that almost never requires an antibiotic was coded (R20.24, p<0.0001) were most strongly correlated with inappropriate prescribing.

    Conclusion: Rate of antibiotic prescribing in visits where any respiratory tract diagnosis was coded and rate of antibiotic prescribing in visits where a respiratory tract diagnosis that almost never requires an antibiotic was coded may be useful proxies to estimate the rate of inappropriate prescribing for ARTIs. This study could inform ambulatory antibiotic benchmarking metrics and interventions to decrease inappropriate antibiotic prescribing for ARTIs in ambulatory settings.

    Keith W. Hamilton, MD1, Kathleen O. Degnan, MD2, Valerie Cluzet, MD3, Leigh Cressman, MA4, Afia B. Adu-Gyamfi, BA4, Pam Tolomeo, MPH4, Michael Z. David, MD, PhD3 and for the CDC Prevention Epicenters Program, (1)Medicine - Infectious Diseases, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, (2)Infectious Diseases, Hospital of the University of Pennsylvania, Philadelphia, PA, (3)Division of Infectious Diseases, Hospital of the University of Pennsylvania, Philadelphia, PA, (4)Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA

    Disclosures:

    K. W. Hamilton, None

    K. O. Degnan, None

    V. Cluzet, None

    L. Cressman, None

    A. B. Adu-Gyamfi, None

    P. Tolomeo, None

    M. Z. David, None

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