Division of Urgent Care, Children's Mercy Kansas City, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri.
Antibiotic Resistance Action Center, Department of Environmental and Occupational Health, Milken Institute School of Public Health.
Pediatrics. 2022 Jul 1;150(1). doi: 10.1542/peds.2021-051806.
Urgent care (UC; a convenient site to receive care for ambulatory-sensitive) centers conditions; however, UC clinicians showed the highest rate of inappropriate antibiotic prescriptions among outpatient settings according to national billing data. Antibiotic prescribing practices in pediatric-specific UC centers were not known but assumed to require improvement. The aim of this multisite quality improvement project was to reduce inappropriate antibiotic prescribing practices for 3 target diagnoses in pediatric UC centers by a relative 20% by December 1, 2019.
The Society of Pediatric Urgent Care invited pediatric UC clinicians to participate in a multisite quality improvement study from June 2019 to December 2019. The diagnoses included acute otitis media (AOM), otitis media with effusion, and pharyngitis. Algorithms based on published guidelines were used to identify inappropriate antibiotic prescriptions according to indication, agent, and duration. Sites completed multiple intervention cycles from a menu of publicly available antibiotic stewardship materials. Participants submitted data electronically. The outcome measure was the percentage of inappropriate antibiotic prescriptions for the target diagnoses. Process measures were use of delayed antibiotics for AOM and inappropriate testing in pharyngitis.
From 20 UC centers, 157 providers submitted data from 3833 encounters during the intervention cycles. Overall inappropriate antibiotic prescription rates decreased by a relative 53.9%. Inappropriate antibiotic prescribing decreased from 57.0% to 36.6% for AOM, 54.6% to 48.4% for otitis media with effusion, and 66.9% to 11.7% for pharyngitis.
Participating pediatric UC providers decreased inappropriate antibiotic prescriptions from 60.3% to 27.8% using publicly available interventions.
紧急护理（UC；一个方便的地方，可以为门诊敏感患者提供治疗）中心条件；然而，根据国家计费数据，UC 临床医生在门诊环境中开出的抗生素处方最不恰当。儿科专用 UC 中心的抗生素处方实践情况尚不清楚，但假设需要改进。本多站点质量改进项目的目的是到 2019 年 12 月 1 日，将儿科 UC 中心 3 个目标诊断的不适当抗生素处方率降低相对 20%。
儿科紧急护理协会邀请儿科 UC 临床医生参加 2019 年 6 月至 2019 年 12 月的多站点质量改进研究。这些诊断包括急性中耳炎（AOM）、渗出性中耳炎和咽炎。根据已发表的指南，使用算法根据适应症、药物和持续时间来确定不适当的抗生素处方。各站点从公开提供的抗生素管理材料菜单中完成多个干预周期。参与者通过电子方式提交数据。结果衡量标准是目标诊断的不适当抗生素处方的百分比。过程衡量标准是 AOM 中延迟使用抗生素和咽炎中不适当的检查。
来自 20 个 UC 中心的 157 名提供者在干预周期中从 3833 次就诊中提交了数据。总体而言，不适当的抗生素处方率下降了相对 53.9%。AOM 的不适当抗生素处方率从 57.0%降至 36.6%，渗出性中耳炎的不适当抗生素处方率从 54.6%降至 48.4%，咽炎的不适当抗生素处方率从 66.9%降至 11.7%。
使用公开的干预措施，参与儿科 UC 提供者将不适当的抗生素处方从 60.3%降至 27.8%。
