Holly M Frost1, Yingbo Lou2, Amy Keith3, Andrew Byars4, Timothy C Jenkins5. 1. Department of Pediatrics, Denver Health, Denver, CO; Center for Health Systems Research, Office of Research, Denver Health, Denver, CO; Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO. Electronic address: Holly.frost@dhha.org. 2. Department of Ambulatory Care Services, Denver Health, Denver, CO. 3. Center for Health Systems Research, Office of Research, Denver Health, Denver, CO. 4. Department of Surgery, Denver Health, Denver, CO. 5. Department of Medicine, Division of Infectious Diseases, Denver Health, Denver, CO; Department of Medicine, Division of Infectious Diseases, University of Colorado School of Medicine, Aurora, CO.
Abstract
OBJECTIVE: To compare the effectiveness of 2 interventions in improving prescribing of guideline-concordant durations of therapy for acute otitis media (AOM). STUDY DESIGN: This was a quasi-experimental mixed methods analysis that compared a bundled quality improvement intervention consisting of individualized audit and feedback, education, and electronic health record (EHR) changes to an EHR-only intervention. The bundle was implemented in 3 pediatric clinics from January to August 2020 and an EHR-only intervention was implemented in 6 family medicine clinics. The primary outcome measure was prescription of an institutional guideline-concordant 5-day duration of therapy for children ≥2 years of age with uncomplicated AOM. Propensity score matching and differences-in-differences analysis weighted with inverse probability of treatment were completed. Implementation outcomes were assessed using the Reach, Effectiveness, Adoption, Implementation, Maintenance Framework. Balance measures included treatment failure and recurrence. RESULTS: In total, 1017 encounters for AOM were included from February 2019 to August 2020. Guideline-concordant prescribing increased from 14.4% to 63.8% (difference = 49.4%) in clinics that received the EHR-only intervention and from 10.6% to 85.2% (difference = 74.6%) in clinics that received the bundled intervention. In the adjusted analysis, the bundled intervention improved guideline-concordant durations by an additional 26.4% (P < .01) compared with the EHR-only intervention. Providers identified EHR-prescription field changes as the most helpful components. There were no differences in treatment failure or recurrence rates between baseline and either intervention. CONCLUSIONS: Both interventions resulted in improved prescribing of guideline-concordant durations of antibiotics. The bundled intervention improved prescribing more than an EHR-only intervention and was acceptable to providers.
OBJECTIVE: To compare the effectiveness of 2 interventions in improving prescribing of guideline-concordant durations of therapy for acute otitis media (AOM). STUDY DESIGN: This was a quasi-experimental mixed methods analysis that compared a bundled quality improvement intervention consisting of individualized audit and feedback, education, and electronic health record (EHR) changes to an EHR-only intervention. The bundle was implemented in 3 pediatric clinics from January to August 2020 and an EHR-only intervention was implemented in 6 family medicine clinics. The primary outcome measure was prescription of an institutional guideline-concordant 5-day duration of therapy for children ≥2 years of age with uncomplicated AOM. Propensity score matching and differences-in-differences analysis weighted with inverse probability of treatment were completed. Implementation outcomes were assessed using the Reach, Effectiveness, Adoption, Implementation, Maintenance Framework. Balance measures included treatment failure and recurrence. RESULTS: In total, 1017 encounters for AOM were included from February 2019 to August 2020. Guideline-concordant prescribing increased from 14.4% to 63.8% (difference = 49.4%) in clinics that received the EHR-only intervention and from 10.6% to 85.2% (difference = 74.6%) in clinics that received the bundled intervention. In the adjusted analysis, the bundled intervention improved guideline-concordant durations by an additional 26.4% (P < .01) compared with the EHR-only intervention. Providers identified EHR-prescription field changes as the most helpful components. There were no differences in treatment failure or recurrence rates between baseline and either intervention. CONCLUSIONS: Both interventions resulted in improved prescribing of guideline-concordant durations of antibiotics. The bundled intervention improved prescribing more than an EHR-only intervention and was acceptable to providers.
Authors: Allan S Lieberthal; Aaron E Carroll; Tasnee Chonmaitree; Theodore G Ganiats; Alejandro Hoberman; Mary Anne Jackson; Mark D Joffe; Donald T Miller; Richard M Rosenfeld; Xavier D Sevilla; Richard H Schwartz; Pauline A Thomas; David E Tunkel Journal: Pediatrics Date: 2013-02-25 Impact factor: 7.124
Authors: Heather L Young; Katherine C Shihadeh; Alisha A Skinner; Bryan C Knepper; Jeffrey Sankoff; Jeremy Voros; Timothy C Jenkins Journal: Infect Control Hosp Epidemiol Date: 2018-06-21 Impact factor: 3.254
Authors: Jeffrey S Gerber; Rachael K Ross; Matthew Bryan; A Russell Localio; Julia E Szymczak; Richard Wasserman; Darlene Barkman; Folasade Odeniyi; Kathryn Conaboy; Louis Bell; Theoklis E Zaoutis; Alexander G Fiks Journal: JAMA Date: 2017-12-19 Impact factor: 56.272
Authors: Timothy C Jenkins; Teresa Hulett; Bryan C Knepper; Katherine C Shihadeh; Marc J Meyer; Gerard R Barber; John H Hammer; Heidi L Wald Journal: Clin Infect Dis Date: 2018-10-30 Impact factor: 9.079
Authors: Jeffrey S Gerber; Priya A Prasad; Alexander G Fiks; A Russell Localio; Robert W Grundmeier; Louis M Bell; Richard C Wasserman; Ron Keren; Theoklis E Zaoutis Journal: JAMA Date: 2013-06-12 Impact factor: 56.272