A Multisite Collaborative to Decrease Inappropriate Antibiotics in Urgent Care Centers

Authors

Amanda Nedved, Division of Urgent Care, Children's Mercy Kansas City, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri.
Melody Fung, Antibiotic Resistance Action Center, Department of Environmental and Occupational Health, Milken Institute School of Public Health.
Destani Bizune, Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.
Cindy M. Liu, Antibiotic Resistance Action Center, Department of Environmental and Occupational Health, Milken Institute School of Public Health.
Jill Obremskey, Tennessee Department of Health, Nashville, Tennessee.
Katherine E. Fleming-Dutra, Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.
Rana F. Hamdy, Department of Pediatrics, School of Medicine and Health Sciences, George Washington University, Washington, District of Columbia.
Amanda Montalbano, Division of Urgent Care, Children's Mercy Kansas City, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri.

Document Type

Journal Article

Publication Date

7-1-2022

Journal

Pediatrics

Volume

150

Issue

1

DOI

10.1542/peds.2021-051806

Abstract

BACKGROUND: Urgent care (UC; a convenient site to receive care for ambulatory-sensitive) centers conditions; however, UC clinicians showed the highest rate of inappropriate antibiotic prescriptions among outpatient settings according to national billing data. Antibiotic prescribing practices in pediatric-specific UC centers were not known but assumed to require improvement. The aim of this multisite quality improvement project was to reduce inappropriate antibiotic prescribing practices for 3 target diagnoses in pediatric UC centers by a relative 20% by December 1, 2019. METHODS: The Society of Pediatric Urgent Care invited pediatric UC clinicians to participate in a multisite quality improvement study from June 2019 to December 2019. The diagnoses included acute otitis media (AOM), otitis media with effusion, and pharyngitis. Algorithms based on published guidelines were used to identify inappropriate antibiotic prescriptions according to indication, agent, and duration. Sites completed multiple intervention cycles from a menu of publicly available antibiotic stewardship materials. Participants submitted data electronically. The outcome measure was the percentage of inappropriate antibiotic prescriptions for the target diagnoses. Process measures were use of delayed antibiotics for AOM and inappropriate testing in pharyngitis. RESULTS: From 20 UC centers, 157 providers submitted data from 3833 encounters during the intervention cycles. Overall inappropriate antibiotic prescription rates decreased by a relative 53.9%. Inappropriate antibiotic prescribing decreased from 57.0% to 36.6% for AOM, 54.6% to 48.4% for otitis media with effusion, and 66.9% to 11.7% for pharyngitis. CONCLUSIONS: Participating pediatric UC providers decreased inappropriate antibiotic prescriptions from 60.3% to 27.8% using publicly available interventions.

APA Citation

Nedved, Amanda; Fung, Melody; Bizune, Destani; Liu, Cindy M.; Obremskey, Jill; Fleming-Dutra, Katherine E.; Hamdy, Rana F.; and Montalbano, Amanda, "A Multisite Collaborative to Decrease Inappropriate Antibiotics in Urgent Care Centers" (2022). GW Authored Works. Paper 1406.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/1406

Department

Pediatrics