Chiotos Kathleen, Dutcher Lauren, Grundmeier Robert W, Meyahnwi Didien, Lautenbach Ebbing, Neuhauser Melinda M, Hicks Lauri A, Hamilton Keith W, Li Yun, Szymczak Julia E, Muller Brandi M, Congdon Morgan, Kane Emily, Hart Jessica, Utidjian Levon, Cressman Leigh, Jaskowiak-Barr Anne, Gerber Jeffrey S
Division of Critical Care Medicine, Department of Anesthesiology and Critical Care, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
Division of Infectious Diseases, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
Clin Infect Dis. 2025 Feb 24;80(2):263-270. doi: 10.1093/cid/ciae593.
Feedback reports summarizing clinician performance are effective tools for improving antibiotic use in the ambulatory setting, but the effectiveness of feedback reports in the hospital setting is unknown.
Quasi-experimental study conducted between December 2021 and November 2023 within a pediatric health system measuring the impact of clinician feedback reports delivered by email and reviewed in a monthly meeting on appropriate antibiotic use in children hospitalized with community-acquired pneumonia (CAP). We used an interrupted time series analysis (ITSA) to estimate the immediate change and change over time in the proportion of CAP encounters adherent to validated metrics of antibiotic choice and duration, then used Poisson regression to estimate intervention effect as a risk ratio (RR).
Preintervention, 213 of 413 (52%) encounters received the appropriate antibiotic choice and duration, which increased to 308 of 387 (80%) postintervention. The ITSA demonstrated an immediate 18% increase in the proportion of CAP encounters receiving both the appropriate antibiotic choice and duration (95% confidence interval [CI]: 3-33%), with no further change over time (-0.3% per month, 95% CI: -2%-2%). In the Poisson model adjusted for age, sex, race, season, site, and intensive care unit admission, the intervention was associated with a 32% increase in the rate of appropriate antibiotic choice and duration (RR 1.32, 95% CI: 1.12-1.56, P < .01). No difference in length of stay or revisits were detected postintervention.
The intervention was associated with an increase in clinician adherence to antibiotic choice and duration recommendations for children hospitalized with CAP.
总结临床医生表现的反馈报告是改善门诊环境中抗生素使用的有效工具，但反馈报告在医院环境中的有效性尚不清楚。
2021年12月至2023年11月在一个儿科医疗系统内进行的准实验研究，测量通过电子邮件发送并在月度会议上审查的临床医生反馈报告对社区获得性肺炎（CAP）住院儿童适当使用抗生素的影响。我们使用中断时间序列分析（ITSA）来估计符合抗生素选择和疗程验证指标的CAP病例比例的即时变化和随时间的变化，然后使用泊松回归将干预效果估计为风险比（RR）。
干预前，413例病例中有213例（52%）接受了适当的抗生素选择和疗程，干预后这一比例增至387例中的308例（80%）。ITSA显示，接受适当抗生素选择和疗程的CAP病例比例即时增加了18%（95%置信区间[CI]：3%-33%），且随时间无进一步变化（每月-0.3%，95%CI：-2%-2%）。在根据年龄、性别、种族、季节、地点和重症监护病房入院情况进行调整的泊松模型中，干预与适当抗生素选择和疗程的比例增加32%相关（RR 1.32，95%CI：1.12-1.56，P<.01）。干预后未发现住院时间或复诊方面的差异。
该干预与临床医生对CAP住院儿童抗生素选择和疗程建议的依从性增加相关。
