Jones George F, Fabre Valeria, Hinson Jeremiah, Levin Scott, Toerper Matthew, Townsend Jennifer, Cosgrove Sara E, Saheed Mustapha, Klein Eili Y
Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Eastern Virginia Medical School, Norfolk, Virginia.
Antimicrob Steward Healthc Epidemiol. 2021 Dec 23;1(1):e70. doi: 10.1017/ash.2021.240. eCollection 2021.
To reduce inappropriate antibiotic prescribing for acute respiratory infections (ARIs) by employing peer comparison with behavioral feedback in the emergency department (ED).
A controlled before-and-after study.
The study was conducted in 5 adult EDs at teaching and community hospitals in a health system.
Adults presenting to the ED with a respiratory condition diagnosis code. Hospitalized patients and those with a diagnosis code for a non-respiratory condition for which antibiotics are or may be warranted were excluded.
After a baseline period from January 2016 to March 2018, 3 EDs implemented a feedback intervention with peer comparison between April 2018 and December 2019 for attending physicians. Also, 2 EDs in the health system served as controls. Using interrupted time series analysis, the inappropriate ARI prescribing rate was calculated as the proportion of antibiotic-inappropriate ARI encounters with a prescription. Prescribing rates were also evaluated for all ARIs. Attending physicians at intervention sites received biannual e-mails with their inappropriate prescribing rate and had access to a dashboard that was updated daily showing their performance relative to their peers.
Among 28,544 ARI encounters, the inappropriate prescribing rate remained stable at the control EDs between the 2 periods (23.0% and 23.8%). At the intervention sites, the inappropriate prescribing rate decreased significantly from 22.0% to 15.2%. Between periods, the overall ARI prescribing rate was 38.1% and 40.6% in the control group and 35.9% and 30.6% in the intervention group.
Behavioral feedback with peer comparison can be implemented effectively in the ED to reduce inappropriate prescribing for ARIs.
通过在急诊科采用同行比较和行为反馈，减少急性呼吸道感染（ARI）的不适当抗生素处方。
一项前后对照研究。
该研究在一个卫生系统的教学医院和社区医院的5个成人急诊科进行。
因呼吸系统疾病诊断编码到急诊科就诊的成年人。排除住院患者以及那些有非呼吸系统疾病诊断编码且有或可能需要使用抗生素的患者。
在2016年1月至2018年3月的基线期之后，2018年4月至2019年12月期间，3个急诊科对主治医生实施了带有同行比较的反馈干预。此外，该卫生系统中的2个急诊科作为对照。使用中断时间序列分析，不适当的ARI处方率计算为开具抗生素的不适当ARI病例数的比例。还对所有ARI的处方率进行了评估。干预地点的主治医生每半年收到一封包含其不适当处方率的电子邮件，并且可以访问一个每日更新的仪表板，该仪表板显示他们相对于同行的表现。
在28544例ARI病例中，对照急诊科在两个时期之间的不适当处方率保持稳定（分别为23.0%和23.8%）。在干预地点，不适当处方率从22.0%显著下降至15.2%。两个时期之间，对照组的总体ARI处方率分别为38.1%和40.6%，干预组为35.9%和30.6%。
在急诊科有效实施同行比较的行为反馈可减少ARI的不适当处方。
