Clegg Herbert W, Bean Rebecca A, Ezzo Stephen J, Hoth Alycia N, Sheedy David J, Anderson William E
Novant Health, Winston-Salem, NC.
Atrium Health, Charlotte, NC.
Pediatr Qual Saf. 2019 Jul 29;4(4):e195. doi: 10.1097/pq9.0000000000000195. eCollection 2019 Jul-Aug.
Inappropriate prescribing of broad-spectrum antibiotics is a significant modifiable risk factor for the development of antibiotic resistance. The objective was to improve guideline-concordant care for 3 common acute respiratory tract infections (ARTIs) and to reduce broad-spectrum antibiotic prescribing in ambulatory pediatric patients.
Quality measures were developed for 3 ARTIs: viral upper respiratory infection (URI), acute bacterial sinusitis (ABS), and acute otitis media (AOM). Among 22 pediatric clinics, a collaborative of 10 was identified for intervention using baseline data for each ARTI, and 3 plan-do-study-act cycles were planned and completed. Outcomes included guideline-concordant antibiotic utilization and broad-spectrum antibiotic prescribing percentage (BSAP%). Comparison in number of diagnoses for the ARTI measures and total antibiotic prescribing over time served as balancing measures.
Collaborative clinics had baseline medians for appropriate or first-line treatment of 70% for URI, 53% for ABS, and 36% for AOM. To reach targets for URI, ABS, and AOM required 6, 14, and 18 months, respectively. At 42 months, performance for all 3 ARTIs remained ≥90%. BSAP% decreased from a baseline of 57% to 34% at 24 months. There was a limited effect from financial incentives but a significant decrease was noted in total antibiotic utilization. Diagnosis shifting may have occurred for URI and ABS while the rates for diagnoses for AOM declined over time.
Through education and peer comparison feedback, guideline-concordant care for 3 ARTIs in collaborative clinics improved and remained beyond above targets and was accompanied by reductions in BSAP% and total antibiotic prescribing.
广谱抗生素的不恰当使用是导致抗生素耐药性产生的一个重要且可改变的风险因素。目标是改善对3种常见急性呼吸道感染（ARTIs）的符合指南的治疗，并减少门诊儿科患者中广谱抗生素的使用。
针对3种ARTIs制定了质量指标：病毒性上呼吸道感染（URI）、急性细菌性鼻窦炎（ABS）和急性中耳炎（AOM）。在22家儿科诊所中，根据每种ARTIs的基线数据确定了10家诊所组成协作组进行干预，并计划并完成了3个计划-执行-研究-改进循环。结果包括符合指南的抗生素使用情况以及广谱抗生素处方百分比（BSAP%）。随着时间推移，对ARTIs指标的诊断数量和总抗生素处方量的比较作为平衡指标。
协作诊所中URI、ABS和AOM的适当或一线治疗的基线中位数分别为70%、53%和36%。达到URI、ABS和AOM的目标分别需要6个月、14个月和18个月。在42个月时，所有3种ARTIs的表现均保持在≥90%。BSAP%从基线的57%在24个月时降至34%。经济激励的效果有限，但总抗生素使用量显著下降。URI和ABS可能发生了诊断转移，而AOM的诊断率随时间下降。
通过教育和同行比较反馈，协作诊所中对3种ARTIs的符合指南的治疗得到改善，并保持在目标之上，同时BSAP%和总抗生素处方量减少。
