Increasing Guideline-Concordant Durations of Antibiotic Therapy for Acute Otitis Media - 21/12/21
, Yingbo Lou, MS 4, Amy Keith, MPH 2, Andrew Byars, BS 5, Timothy C. Jenkins, MD 6, 7Abstract |
Objective |
To compare the effectiveness of 2 interventions in improving prescribing of guideline-concordant durations of therapy for acute otitis media (AOM).
Study design |
This was a quasi-experimental mixed methods analysis that compared a bundled quality improvement intervention consisting of individualized audit and feedback, education, and electronic health record (EHR) changes to an EHR-only intervention. The bundle was implemented in 3 pediatric clinics from January to August 2020 and an EHR-only intervention was implemented in 6 family medicine clinics. The primary outcome measure was prescription of an institutional guideline-concordant 5-day duration of therapy for children ≥2 years of age with uncomplicated AOM. Propensity score matching and differences-in-differences analysis weighted with inverse probability of treatment were completed. Implementation outcomes were assessed using the Reach, Effectiveness, Adoption, Implementation, Maintenance Framework. Balance measures included treatment failure and recurrence.
Results |
In total, 1017 encounters for AOM were included from February 2019 to August 2020. Guideline-concordant prescribing increased from 14.4% to 63.8% (difference = 49.4%) in clinics that received the EHR-only intervention and from 10.6% to 85.2% (difference = 74.6%) in clinics that received the bundled intervention. In the adjusted analysis, the bundled intervention improved guideline-concordant durations by an additional 26.4% (P < .01) compared with the EHR-only intervention. Providers identified EHR-prescription field changes as the most helpful components. There were no differences in treatment failure or recurrence rates between baseline and either intervention.
Conclusions |
Both interventions resulted in improved prescribing of guideline-concordant durations of antibiotics. The bundled intervention improved prescribing more than an EHR-only intervention and was acceptable to providers.
Le texte complet de cet article est disponible en PDF.Abbreviations : ABP, AOM, COVID-19, CSAT, EHR, MOC, OASIS
Plan
| Supported by the Denver Health Pilot Grant program (PI: H.F.). H.F. received salary support from the Eunice Kennedy Shriver National Institute of Child Health and Human Development of the National Institutes of Health (K23HD099925). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The authors declare no conflicts of interest. |
Vol 240
P. 221 - janvier 2022 Retour au numéro
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