TY - JOUR
T1 - Improving antimicrobial prescribing for upper respiratory infections in the emergency department
T2 - Implementation of peer comparison with behavioral feedback
AU - Jones, George F.
AU - Fabre, Valeria
AU - Hinson, Jeremiah
AU - Levin, Scott
AU - Toerper, Matthew
AU - Townsend, Jennifer
AU - Cosgrove, Sara E.
AU - Saheed, Mustapha
AU - Klein, Eili Y.
N1 - Funding Information:
This research was supported in part by the Agency for Healthcare Research and Quality (AHRQ), U.S. Department of Health and Human Services (HHS) under award number R18 HS026640-02. The authors are solely responsible for this document’s contents, findings, and conclusions, which do not necessarily represent the views of AHRQ. Readers should not interpret any statement in this report as an official position of AHRQ or of HHS.
Publisher Copyright:
© The Author(s), 2021. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America.
PY - 2021/12/23
Y1 - 2021/12/23
N2 - Objective: To reduce inappropriate antibiotic prescribing for acute respiratory infections (ARIs) by employing peer comparison with behavioral feedback in the emergency department (ED). Design: A controlled before-and-after study. Setting: The study was conducted in 5 adult EDs at teaching and community hospitals in a health system. Patients: 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. Interventions: 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. Results: 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. Conclusions: Behavioral feedback with peer comparison can be implemented effectively in the ED to reduce inappropriate prescribing for ARIs.
AB - Objective: To reduce inappropriate antibiotic prescribing for acute respiratory infections (ARIs) by employing peer comparison with behavioral feedback in the emergency department (ED). Design: A controlled before-and-after study. Setting: The study was conducted in 5 adult EDs at teaching and community hospitals in a health system. Patients: 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. Interventions: 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. Results: 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. Conclusions: Behavioral feedback with peer comparison can be implemented effectively in the ED to reduce inappropriate prescribing for ARIs.
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U2 - 10.1017/ash.2021.240
DO - 10.1017/ash.2021.240
M3 - Article
C2 - 36168488
AN - SCOPUS:85129734176
SN - 2732-494X
VL - 1
JO - Antimicrobial Stewardship and Healthcare Epidemiology
JF - Antimicrobial Stewardship and Healthcare Epidemiology
IS - 1
M1 - e70
ER -