Daley Matthew F, Reifler Liza M, Sterrett Andrew T, Poole Nicole M, Winn D Brian, Steiner John F, Arnold Rehring Sharisse M
Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO; Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO.
Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO.
J Pediatr. 2024 Nov;274:114155. doi: 10.1016/j.jpeds.2024.114155. Epub 2024 Jun 17.
To assess whether a two-phase intervention was associated with improvements in antibiotic prescribing among nonhospitalized children with community-acquired pneumonia.
In a large health care organization, a first intervention phase was implemented in September 2020 directed at antibiotic choice and duration for children 2 months through 17 years of age with pneumonia. Activities included clinician education and implementation of a pneumonia-specific order set in the electronic health record. In October 2021, a second phase comprised additional education and order set revisions. A narrow spectrum antibiotic (eg, amoxicillin) was recommended in most circumstances. Electronic health record data were used to identify pneumonia cases and antibiotics ordered. Using interrupted time series analyses, antibiotic choice and duration after phase one (September 2020-September 2021) and after phase two (October 2021-October 2022) were compared with a preintervention prepandemic period (January 2016-early March 2020).
Overall, 3570 cases of community-acquired pneumonia were identified: 3246 cases preintervention, 98 post-phase one, and 226 post-phase two. The proportion receiving narrow spectrum monotherapy increased from 40.6% preintervention to 68.4% post-phase one to 69.0% post-phase two (P < .001). For children with an initial narrow spectrum antibiotic, duration decreased from preintervention (mean duration 9.9 days, SD 0.5 days) to post-phase one (mean 8.2, SD 1.9) to post-phase two (mean 6.8, SD 2.3) periods (P < .001).
A two-phase intervention with educational sessions combined with clinical decision support was associated with sustained improvements in antibiotic choice and duration among children with community-acquired pneumonia.
评估两阶段干预措施是否与社区获得性肺炎非住院儿童抗生素处方的改善相关。
在一个大型医疗保健机构中，2020年9月实施了第一阶段干预，针对2个月至17岁患肺炎儿童的抗生素选择和使用时长。活动包括临床医生教育以及在电子健康记录中实施特定的肺炎医嘱集。2021年10月，第二阶段包括额外的教育和医嘱集修订。在大多数情况下推荐使用窄谱抗生素（如阿莫西林）。利用电子健康记录数据识别肺炎病例和所开具的抗生素。采用中断时间序列分析，将第一阶段（2020年9月至2021年9月）和第二阶段（2021年10月至2022年10月）后的抗生素选择和使用时长与干预前的大流行前时期（2016年1月至2020年3月初）进行比较。
总体而言，共识别出3570例社区获得性肺炎病例：干预前3246例，第一阶段后98例，第二阶段后226例。接受窄谱单药治疗的比例从干预前的40.6%增至第一阶段后的68.4%，再到第二阶段后的69.0%（P <.001）。对于最初使用窄谱抗生素的儿童，使用时长从干预前（平均时长9.9天，标准差0.5天）降至第一阶段后（平均8.2天，标准差1.9天），再到第二阶段后（平均6.8天，标准差2.3天）（P <.001）。
结合教育课程与临床决策支持的两阶段干预与社区获得性肺炎儿童抗生素选择和使用时长的持续改善相关。
