Guzman Adriana, Brown Tiffany, Lee Ji Young, Fischer Michael A, Friedberg Mark W, Chua Kao-Ping, Linder Jeffrey A
Department of Medicine, Division of General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL 60202, USA.
Department of Medicine, Section of General Internal Medicine, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA 02118, USA.
Antibiotics (Basel). 2022 Nov 4;11(11):1554. doi: 10.3390/antibiotics11111554.
Ambulatory antibiotic stewards, researchers, and performance measurement programs choose different durations to associate diagnoses with antibiotic prescriptions. We assessed how the apparent appropriateness of antibiotic prescribing changes when using different look-back and look-forward periods. Examining durations of 0 days (same-day), -3 days, -7 days, -30 days, ±3 days, ±7 days, and ±30 days, we classified all ambulatory antibiotic prescriptions in the electronic health record of an integrated health care system from 2016 to 2019 (714,057 prescriptions to 348,739 patients by 2391 clinicians) as chronic, appropriate, potentially appropriate, inappropriate, or not associated with any diagnosis. Overall, 16% percent of all prescriptions were classified as chronic infection related. Using only same-day diagnoses, appropriate, potentially appropriate, inappropriate, and not-associated antibiotics, accounted for 14%, 36%, 22%, and 11% of prescriptions, respectively. As the duration of association increased, the proportion of appropriate antibiotics stayed the same (range, 14% to 18%), potentially appropriate antibiotics increased (e.g., 43% for -30 days), inappropriate stayed the same (range, 22% to 24%), and not-associated antibiotics decreased (e.g., 2% for -30 days). Using the longest look-back-and-forward duration (±30 days), appropriate, potentially appropriate, inappropriate, and not-associated antibiotics, accounted for 18%, 44%, 20%, and 2% of prescriptions, respectively. Ambulatory programs and studies focused on appropriate or inappropriate antibiotic prescribing can reasonably use a short duration of association between an antibiotic prescription and diagnosis codes. Programs and studies focused on potentially appropriate antibiotic prescribing might consider examining longer durations.
门诊抗生素管理专员、研究人员和绩效评估项目在将诊断与抗生素处方关联时选择了不同的时间段。我们评估了在使用不同的回顾期和展望期时，抗生素处方的表面适宜性是如何变化的。研究了0天（当日）、-3天、-7天、-30天、±3天、±7天和±30天的时间段，我们将2016年至2019年一个综合医疗系统电子健康记录中的所有门诊抗生素处方（2391名临床医生为348,739名患者开具的714,057张处方）分类为慢性、适宜、可能适宜、不适宜或与任何诊断无关。总体而言，所有处方中有16%被归类为与慢性感染相关。仅使用当日诊断时，适宜、可能适宜、不适宜和无关联的抗生素分别占处方的14%、36%、22%和11%。随着关联时间段的增加，适宜抗生素的比例保持不变（范围为14%至18%），可能适宜的抗生素增加（例如，-30天时为43%），不适宜的保持不变（范围为22%至24%），无关联的抗生素减少（例如，-30天时为2%）。使用最长的回顾和展望时间段（±30天）时，适宜、可能适宜、不适宜和无关联的抗生素分别占处方的18%、44%、20%和2%。专注于适宜或不适宜抗生素处方的门诊项目和研究可以合理使用抗生素处方与诊断编码之间较短的关联时间段。专注于可能适宜抗生素处方的项目和研究可能会考虑研究更长的时间段。
