Lilliam Ambroggio1,2,3, Colleen Mangeot2, Eileen Murtagh Kurowski3,4, Camille Graham3,5,6, Paul Korn7, Marcie Strasser8, Charles Cavallo9, Katherine Brady10, Suzanne Campanella11, Caitlin Clohessy11, William B Brinkman3,5, Samir S Shah11,3,12. 1. Divisions of Hospital Medicine, lilliam.ambroggio@cchmc.org. 2. Biostatistics and Epidemiology. 3. Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio. 4. Emergency Medicine. 5. General and Community Pediatrics, and. 6. Mid City Pediatrics, Cincinnati, Ohio. 7. Landen Lake Pediatrics, Mason, Ohio. 8. Pediatric Care Inc, Cincinnati, Ohio. 9. Pediatric Associates PSC, Crestview Hills, Kentucky; and. 10. Anderson Hills Pediatrics, Cincinnati, Ohio. 11. Divisions of Hospital Medicine. 12. Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
Abstract
BACKGROUND: The Pediatric Infectious Diseases Society and Infectious Diseases Society of America national childhood community-acquired pneumonia (CAP) guideline encouraged the standard evaluation and treatment of children who were managed as outpatients. Our objectives were to (1) increase adherence to guideline-recommended diagnostics and antibiotic treatment of CAP at 5 pediatric primary care practices (PPCPs) by using quality-improvement methods and (2) evaluate the association between guideline adherence and unscheduled follow-up visits. METHODS: Immunocompetent children >3 months of age with no complex chronic conditions and who were diagnosed with CAP were eligible for inclusion in this stepped-wedge study. Interventions were focused on education, knowledge of colleagues' prescribing practices, and feedback sessions. Statistical process control charts were used to assess changes in recommendations and antibiotic treatment. Unscheduled follow-up visits were compared across time by using generalized estimating equations that were clustered by PPCP. RESULTS: CAP was diagnosed in 1906 children. Guideline recommended therapy and pulse oximetry use increased from a mean baseline of 24.9% to a mean of 68.0% and from 4.3% to 85.0%, respectively, over the study period. Among children >5 years of age, but not among those who were younger, the receipt of guideline recommended antibiotics, as compared with nonguideline therapy, was associated with the increased likelihood of unscheduled follow-up (adjusted odds ratio, 2.12; 95% confidence interval: 1.31-3.43). Chest radiographs and complete blood cell counts were rarely performed at baseline. CONCLUSIONS: Recommendations for limited use of chest radiographs and complete blood cell counts and standardized antibiotic therapy in children is supported at PPCPs. However, the guideline may need to include macrolide monotherapy as appropriate antibiotic therapy for older children.
BACKGROUND: The Pediatric Infectious Diseases Society and Infectious Diseases Society of America national childhood community-acquired pneumonia (CAP) guideline encouraged the standard evaluation and treatment of children who were managed as outpatients. Our objectives were to (1) increase adherence to guideline-recommended diagnostics and antibiotic treatment of CAP at 5 pediatric primary care practices (PPCPs) by using quality-improvement methods and (2) evaluate the association between guideline adherence and unscheduled follow-up visits. METHODS: Immunocompetent children >3 months of age with no complex chronic conditions and who were diagnosed with CAP were eligible for inclusion in this stepped-wedge study. Interventions were focused on education, knowledge of colleagues' prescribing practices, and feedback sessions. Statistical process control charts were used to assess changes in recommendations and antibiotic treatment. Unscheduled follow-up visits were compared across time by using generalized estimating equations that were clustered by PPCP. RESULTS: CAP was diagnosed in 1906 children. Guideline recommended therapy and pulse oximetry use increased from a mean baseline of 24.9% to a mean of 68.0% and from 4.3% to 85.0%, respectively, over the study period. Among children >5 years of age, but not among those who were younger, the receipt of guideline recommended antibiotics, as compared with nonguideline therapy, was associated with the increased likelihood of unscheduled follow-up (adjusted odds ratio, 2.12; 95% confidence interval: 1.31-3.43). Chest radiographs and complete blood cell counts were rarely performed at baseline. CONCLUSIONS: Recommendations for limited use of chest radiographs and complete blood cell counts and standardized antibiotic therapy in children is supported at PPCPs. However, the guideline may need to include macrolide monotherapy as appropriate antibiotic therapy for older children.
Authors: Isabela R Marques; Izabela P Calvi; Sara A Cruz; Luana M F Sanchez; Isis F Baroni; Christi Oommen; Eduardo M H Padrao; Paula C Mari Journal: Eur J Pediatr Date: 2022-09-06 Impact factor: 3.860
Authors: Susan C Lipsett; Matthew Hall; Lilliam Ambroggio; Adam L Hersh; Samir S Shah; Thomas V Brogan; Jeffrey S Gerber; Derek J Williams; Carlos G Grijalva; Anne J Blaschke; Mark I Neuman Journal: J Pediatr Date: 2020-10-10 Impact factor: 4.406
Authors: Josephine S van de Maat; Daniella Garcia Perez; Gertjan J A Driessen; Anne-Marie van Wermeskerken; Frank J Smit; Jeroen G Noordzij; Gerdien Tramper-Stranders; Charlie C Obihara; Jeanine Punt; Henriette A Moll; Rianne Oostenbrink Journal: Eur J Pediatr Date: 2021-03-22 Impact factor: 3.183