Acute Otitis Media, Community-acquired Pneumonia, Pharyngitis
Conditions
Keywords
Antibiotic stewardship, Implementation Science, Antibiotic Use, Outpatient antibiotic prescribing, Inpatient antibiotic prescribing
Brief summary
The main goal of this study is to use automated electronic reports to assess and improve guideline-concordant antibiotic use for: 1\) adult inpatients with community-acquired pneumonia; 2) pediatric inpatients with community-acquired pneumonia; 3) adult outpatients with acute pharyngitis; and 4) pediatric outpatients with acute otitis media.
Detailed description
Antibiotic stewardship has been shown to improve patient outcomes, decrease adverse events, and decrease antibiotic resistance. This group of investigators previously partnered with collaborators at the Centers for Disease Control and Prevention and conducted relevant pilot work in developing and validating electronic indicators of inappropriate antibiotic prescribing for 8 conditions, amongst which are the four conditions of interest in this study: adult inpatients with community-acquired pneumonia; pediatric inpatients with community-acquired pneumonia; adult outpatients with acute pharyngitis; and pediatric outpatients with acute otitis media. Methods were developed to generate automatic, routine reports to identify elements of inappropriate antibiotic use including; 1) the decision to initiate antibiotic therapy (pharyngitis and acute otitis media only); 2) the choice of antibiotic agent; and 3) the duration of antibiotic use. The purpose of this project is to assess the impact of these developed electronic indicators on supporting antibiotic stewardship efforts to improve the appropriateness of antibiotic use, as well as the acceptability and feasibility of delivering these reports to prescribers. The investigators aim to: 1. Refine and validate indicators of appropriate antibiotic use by utilizing Electronic Health Record data, including International Classification of Diseases version 10 codes, medications, laboratory data, co-morbid medical conditions, site of care, clinical documentation, prior hospitalizations, and medication exposure. The researchers will validate the definitions of the various conditions and appropriateness captured electronically with a manual chart review of clinical documentation. 2. Implement a scalable and sustainable antimicrobial stewardship feedback report-based intervention for these four conditions informed by a rapid user-centered design process. 3. Track the impact of the stewardship interventions and report to key stakeholders, including prescribers. 4. Create a publicly available toolkit based on the findings of this project that includes: (i) analytic tools and resources for using the automated reports of key indicators to target stewardship interventions and (ii) an implementation guide to inform the application of automated reports to stewardship in the inpatient and outpatient settings. If proven effective, these electronic health record-based approaches hold the promise to greatly enhance the effectiveness and efficiency of antimicrobial stewardship initiatives.
Interventions
OTHERQuasi experimental intervention
The intervention included clinician education and sharing of audit and feedback reports summarizing antibiotic use metrics for each of the four target conditions with treating clinicians.
Sponsors
University of Pennsylvania
Centers for Disease Control and Prevention
Children's Hospital of Philadelphia
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
OTHER
Masking
NONE
Intervention model description
Quasi-experimental study measuring the impact of an antibiotic stewardship intervention consisting of clinician education and audit and feedback reports on antibiotic use for adult inpatients with community acquired pneumonia, pediatric inpatients with community acquired pneumonia, adult outpatients with acute pharyngitis, and pediatric outpatients with acute otitis media.
Eligibility
Sex/Gender
ALL
Healthy volunteers
No
Inclusion criteria
Patient Inclusion Criteria: * Diagnosis of one of four conditions based on ICD-10 diagnostic codes. Patient
Exclusion criteria
* Presence of specific complex chronic conditions * Use of immunocompromising medications * Transfer from another health facility. Clinician Inclusion Criteria: * Prescribing clinicians (including attending physicians, fellows, residents, nurse practitioners, and physician assistants) at one of the participating outpatient practices or inpatient units. * Age ≥ 18 years old * Employed by one of the participating sites Clinician
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Guideline-concordant Antibiotic Use for Children With Acute Otitis Media | Pre-intervention and post-intervention, up to 2 years | Count of participants with acute otitis media with guideline-concordant antibiotic use for all three metrics (decision to prescribe an antibiotic, antibiotic choice, and antibiotic duration). The count of participants with acute otitis media with guideline-concordant antibiotic use for all three metrics was divided by the total number of participants with pediatric acute otitis media who were prescribed antibiotics to generate the percentage of participants receiving guideline-concordant antibiotic use for all three metrics. These proportions were compared for the group of participants in the pre intervention period (1 year) and the post intervention period (1 year). There were not individual participant level measures for this outcome. |
| Guideline-concordant Antibiotic Use for Children With Community-acquired Pneumonia | Pre-intervention and post-intervention, up to 2 years | Count of participants with pediatric community-acquired pneumonia with guideline-concordant antibiotic use for all three metrics (decision to prescribe an antibiotic, antibiotic choice, and antibiotic duration). The count of participants with pediatric community-acquired pneumonia with guideline-concordant antibiotic use for all three metrics was divided by the total number of participants with pediatric community-acquired pneumonia to generate the percentage of participants receiving guideline-concordant antibiotic use for all three metrics. These proportions were compared for the group of participants in the pre intervention period (1 year) and the post intervention period (1 year). There were not individual participant level measures for this outcome. |
| Guideline-concordant Antibiotic Use for Adults With Pharyngitis | Pre-intervention and post-intervention, up to 2 years | Count of participants with pharyngitis with guideline-concordant antibiotic use for all three metrics (decision to prescribe an antibiotic, antibiotic choice, and antibiotic duration). The count of participants with pharyngitis with guideline-concordant antibiotic use for all three metrics was divided by the total number of participants with pharyngitis to generate the percentage of participants receiving guideline-concordant antibiotic use for all three metrics. These proportions were compared for the group of participants in the pre intervention period (1 year) and the post intervention period (1 year). There were not individual participant level measures for this outcome. |
| Guideline-concordant Antibiotic Use for Adults With Community-acquired Pneumonia | Pre-intervention and post-intervention, up to 2 years | Count of participants with community-acquired pneumonia with guideline-concordant antibiotic use for all three metrics (decision to prescribe an antibiotic, antibiotic choice, and antibiotic duration). The count of participants with community-acquired pneumonia with guideline-concordant antibiotic use for all three metrics was divided by the total number of participants with community-acquired pneumonia to generate the percentage of participants receiving guideline-concordant antibiotic use for all three metrics. These proportions were compared for the group of participants in the pre intervention period (1 year) and the post intervention period (1 year). There were not individual participant level measures for this outcome. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| 30-day Readmissions for Community Acquired Pneumonia in Adults | 30 days | Count of participants with a readmission for community-acquired pneumonia within 30 days of discharge following an index hospitalization for community-acquired pneumonia. The count of participants with a readmission for community-acquired pneumonia was divided by the total number of participants with community-acquired pneumonia to generate the percentage of participants with readmissions within 30 days of discharge following an index hospitalization for community-acquired pneumonia. |
| Guideline-concordant Antibiotic Choice for Pediatric Community Acquired Pneumonia | Pre-intervention and post-intervention, up to 2 years | Count of participants with pediatric community-acquired pneumonia with guideline-concordant antibiotic use for antibiotic choice. The count of participants with pediatric community-acquired pneumonia with guideline-concordant antibiotic use for this metric was divided by the total number of participants with pediatric community-acquired pneumonia to generate the percentage of participants receiving guideline-concordant antibiotic use for antibiotic choice. These proportions were compared for the group of participants in the pre intervention period (1 year) and the post intervention period (1 year). There were not individual participant level measures for this outcome. |
| Guideline-concordant Antibiotic Duration for Pediatric Community Acquired Pneumonia | Pre-intervention and post-intervention, up to 2 years | Count of participants with pediatric community-acquired pneumonia with guideline-concordant antibiotic use for antibiotic duration. The count of participants with pediatric community-acquired pneumonia with guideline-concordant antibiotic use for this metric was divided by the total number of participants with pediatric community-acquired pneumonia to generate the percentage of participants receiving guideline-concordant antibiotic use for antibiotic duration. These proportions were compared for the group of participants in the pre intervention period (1 year) and the post intervention period (1 year). There were not individual participant level measures for this outcome. |
| 28-day Community Acquired Pneumonia-related Outpatient Revisits (Emergency Department, Urgent Care, or Primary Care) in Children | 28 days | Count of participants with pediatric community-acquired pneumonia with a return visit in the outpatient setting (emergency department, urgent care, or primary care) for pediatric community acquired pneumonia within 28 days of discharge following index hospitalization for pediatric community acquired pneumonia. The count of participants with pediatric community-acquired pneumonia with a return visit in the outpatient setting was divided by the total number of participants with pediatric community-acquired pneumonia to generate the percentage of participants with a return visit in the outpatient setting. |
| 28-day Readmissions for Pediatric Community Acquired Pneumonia | 28 days | Count of participants with a readmission for community-acquired pneumonia within 28 days of discharge following an index hospitalization for community-acquired pneumonia. The count of participants with a readmission for community-acquired pneumonia was divided by the total number of participants with community-acquired pneumonia to generate the percentage of participants with readmissions within 28 days of discharge following an index hospitalization for community-acquired pneumonia. |
| Guideline-concordant Decision to Prescribe Antibiotics for Adult Pharyngitis | Pre-intervention and post-intervention, up to 2 years | Count of participants with pharyngitis for which the decision to prescribe an antibiotic was correct. The count of participants with pharyngitis for which the decision to prescribe an antibiotic was correct was divided by the total number of participants with pharyngitis to generate the percentage of participants for which the decision to prescribe an antibiotic was correct. These proportions were compared for the group of participants in the pre intervention period (1 year) and the post intervention period (1 year). There were not individual participant level measures for this outcome. |
| Guideline-concordant Antibiotic Choice Adult Pharyngitis | Pre-intervention and post-intervention, up to 2 years | Count of participants with adult pharyngitis with guideline-concordant antibiotic use for antibiotic choice. The count of participants with pharyngitis with guideline-concordant antibiotic use for this metric was divided by the total number of participants with pharyngitis to generate the percentage of participants receiving guideline-concordant antibiotic use for antibiotic choice. These proportions were compared for the group of participants in the pre intervention period (1 year) and the post intervention period (1 year). There were not individual participant level measures for this outcome. |
| 30-day Pharyngitis Outpatient Revisits (Emergency Department, Urgent Care, or Primary Care) in Adults | 30 days | Count of participants with adult pharyngitis with a return visit in the outpatient setting (emergency department, urgent care, or primary care) for pharyngitis within 30 days of discharge following index hospitalization for adult pharyngitis. The count of participants with pharyngitis with a return visit in the outpatient setting was divided by the total number of participants with pharyngitis to generate the percentage of participants with a return visit in the outpatient setting. |
| 30-day Deep Neck Space Infection Admission | 30 days | Count of participants with a readmission for deep neck space infection within 30 days of index encounter for pharyngitis. The count of participants with a readmission for deep neck space infection was divided by the total number of participants with adult pharyngitis to generate the percentage of participants with readmissions for deep neck space infection within 30 days of index encounter for pharyngitis. |
| Guideline-concordant Decision to Prescribe Antibiotics for Pediatric Acute Otitis Media | Pre-intervention and post-intervention, up to 2 years | Count of participants with pediatric acute otitis media for which the decision to prescribe an antibiotic was correct. The count of participants with pediatric acute otitis media for which the decision to prescribe an antibiotic was correct was divided by the total number of participants with pediatric acute otitis media to generate the percentage of participants for which the decision to prescribe an antibiotic was correct. These proportions were compared for the group of participants in the pre intervention period (1 year) and the post intervention period (1 year). There were not individual participant level measures for this outcome. |
| Guideline-concordant Antibiotic Choice for Pediatric Acute Otitis Media | Pre-intervention and post-intervention, up to 2 years | Count of participants with pediatric acute otitis media with guideline-concordant antibiotic use for antibiotic choice. The count of participants with pediatric acute otitis media visits with guideline-concordant antibiotic use for this metric was divided by the total number of participants with pediatric acute otitis media who were prescribed antibiotics to generate the percentage of participants receiving guideline-concordant antibiotic use for antibiotic choice. These proportions were compared for the group of participants in the pre intervention period (1 year) and the post intervention period (1 year). There were not individual participant level measures for this outcome. |
| Guideline-concordant Antibiotic Duration for Pediatric Acute Otitis Media | Pre-intervention and post-intervention, up to 2 years | Count of participants with pediatric acute otitis media with guideline-concordant antibiotic use for antibiotic duration. The count of participants with pediatric acute otitis media with guideline-concordant antibiotic use for this metric was divided by the total number of participants with pediatric acute otitis media who were prescribed antibiotics to generate the percentage of participants receiving guideline-concordant antibiotic use for antibiotic duration. These proportions were compared for the group of participants in the pre intervention period (1 year) and the post intervention period (1 year). There were not individual participant level measures for this outcome. |
| 28-day Acute Otitis Media-related Outpatient Revisits (Emergency Department, Urgent Care, or Primary Care) | 28 days | Count of participants with pediatric acute otitis media with a return visit in the outpatient setting (emergency department, urgent care, or primary care) for pediatric acute otitis media within 28 days of the index acute otitis media encounter. The count of participants with pediatric acute otitis media with a return visit in the outpatient setting was divided by the total number of participants with pediatric acute otitis media to generate the percentage of participants with a return visit in the outpatient setting. |
| 28-day Mastoiditis or Intracranial Infection Admissions | 28 days | Count of participants with a readmission for mastoiditis or intracranial infection within 28 days of the index encounter for pediatric acute otitis media. The count of participants with a readmission for mastoiditis or intracranial infection was divided by the total number of participants with pediatric acute otitis media to generate the percentage of participants with readmissions within 28 days of discharge following an index hospitalization for acute otitis media. |
| Guideline-concordant Decision to Not Prescribe Antibiotics for Pediatric Acute Otitis Media | Pre-intervention and post-intervention, up to 2 years | Count of participants with pediatric acute otitis media with guideline-concordant antibiotic use for appropriate decision not to prescribe antibiotics. The count of participants with pediatric acute otitis media with an appropriate decision not to prescribe antibiotics was divided by the total number of participants with no antibiotics prescribed to generate the percentage of participants appropriately not prescribed antibiotics for acute otitis media. These proportions were compared for the group of participants in the pre intervention period (1 year) and the post intervention period (1 year). There were not individual participant level measures for this outcome. |
| Guideline-concordant Decision to Not Prescribe Antibiotics for Adult Pharyngitis | Pre-intervention and post-intervention, up to 2 years | Count of participants with adult pharyngitis with guideline-concordant antibiotic use for appropriate decision not to prescribe antibiotics. The count of participants with adult pharyngitis with an appropriate decision not to prescribe antibiotics was divided by the total number of participants with no antibiotics prescribed to generate the percentage of participants appropriately not prescribed antibiotics for pharyngitis. These proportions were compared for the group of participants in the pre intervention period (1 year) and the post intervention period (1 year). There were not individual participant level measures for this outcome. |
| Guideline-concordant Antibiotic Duration for Adult Pharyngitis | Pre-intervention and post-intervention, up to 2 years | Count of participants with adult pharyngitis with guideline-concordant antibiotic use for antibiotic duration. The count of participants with pharyngitis with guideline-concordant antibiotic use for this metric was divided by the total number of participants with pharyngitis to generate the percentage of participants receiving guideline-concordant antibiotic use for antibiotic duration. These proportions were compared for the group of participants in the pre intervention period (1 year) and the post intervention period (1 year). There were not individual participant level measures for this outcome. |
| Guideline-concordant Antibiotic Choice for Adults Hospitalized With Community Acquired Pneumonia | Pre-intervention and post-intervention, up to 2 years | Count of participants with community-acquired pneumonia with guideline-concordant antibiotic use for antibiotic choice. The count of participants with community-acquired pneumonia with guideline-concordant antibiotic use for this metric was divided by the total number of participants with community-acquired pneumonia to generate the percentage of participants receiving guideline-concordant antibiotic use for antibiotic choice. These proportions were compared for the group of participants in the pre intervention period (1 year) and the post intervention period (1 year). There were not individual participant level measures for this outcome. |
| Guideline-concordant Antibiotic Duration for Adults Hospitalized With Community Acquired Pneumonia | Pre-intervention and post-intervention, up to 2 years | Count of participants with community-acquired pneumonia with guideline-concordant antibiotic use for antibiotic duration. The count of participants with community-acquired pneumonia with guideline-concordant antibiotic use for this metric was divided by the total number of participants with community-acquired pneumonia to generate the percentage of participants receiving guideline-concordant antibiotic use for antibiotic duration. These proportions were compared for the group of participants in the pre intervention period (1 year) and the post intervention period (1 year). There were not individual participant level measures for this outcome. |
| 30-day Community Acquired Pneumonia-related Outpatient Revisits (Emergency Department, Urgent Care, or Primary Care) in Adults | 30 days | Count of participants with community-acquired pneumonia with a return visit in the outpatient setting (emergency department, urgent care, or primary care) for community acquired pneumonia within 30 days of discharge following index hospitalization for adult community acquired pneumonia. The count of participants with community-acquired pneumonia with a return visit in the outpatient setting was divided by the total number of participants with community-acquired pneumonia to generate the percentage of participants with a return visit in the outpatient setting. |
Other
| Measure | Time frame | Description |
|---|---|---|
| Feasibility of Intervention - Outpatient | One time measure in the post intervention time period | Feasibility is defined as the extent to which the intervention can be carried out in the clinical setting. The feasibility of intervention measure is the full name of this scale. The feasibility of intervention scale consists of four questions, each with 5 possible responses (completely disagree, disagree, neither agree or disagree, agree, or completely agree) on a numeric 1-5 scale. These four subscores are summed to generate a total score, with possible scores ranging from 4-20. A higher score indicates that the intervention is more feasible. There are no validated cutoffs for feasibility. The mean total score and standard deviation of the mean total score for all respondents are reported. The feasibility of intervention measure was assessed by a one time survey in the post-intervention time period. |
| Acceptability of Intervention Measure - Inpatient | One time measure in the post intervention time period. | Acceptability is defined as how well the intervention was received by the prescribing clinicians. The acceptability of intervention measure is the full name of this scale. The acceptability of intervention scale consists of four questions, each with 5 possible responses (completely disagree, disagree, neither agree or disagree, agree, or completely agree) on a numeric 1-5 scale. These four subscores are summed to generate a total score, with possible scores ranging from 4-20. A higher score indicates that the intervention is more acceptable. There are no validated cutoffs for acceptability. The mean total score and standard deviation of the mean total score for all respondents are reported. The acceptability of intervention measure was assessed by a one time survey in the post-intervention time period. |
| Feasibility of Intervention Measure - Inpatient | One time measure in the post intervention time period | Feasibility is defined as the extent to which the intervention can be carried out in the clinical setting. The feasibility of intervention measure is the full name of this scale. The feasibility of intervention scale consists of four questions, each with 5 possible responses (completely disagree, disagree, neither agree or disagree, agree, or completely agree) on a numeric 1-5 scale. These four subscores are summed to generate a total score, with possible scores ranging from 4-20. A higher score indicates that the intervention is more feasible. There are no validated cutoffs for feasibility. The mean total score and standard deviation of the mean total score for all respondents are reported. The feasibility of intervention measure was assessed by a one time survey in the post-intervention time period. |
| Acceptability of Intervention - Outpatient | One time measure in the post intervention time period | Acceptability is defined as how well the intervention was received by the prescribing clinicians. The acceptability of intervention measure is the full name of this scale. The acceptability of intervention scale consists of four questions, each with 5 possible responses (completely disagree, disagree, neither agree or disagree, agree, or completely agree) on a numeric 1-5 scale. These four subscores are summed to generate a total score, with possible scores ranging from 4-20. A higher score indicates that the intervention is more acceptable. There are no validated cutoffs for acceptability. The mean total score and standard deviation of the mean total score for all respondents are reported. The acceptability of intervention measure was assessed by a one time survey in the post-intervention time period. |
Countries
United States
Participant flow
Recruitment details
All patients with one or more of the target conditions during the study period were included.
Pre-assignment details
Clinicians were not enrolled as participants diagnosed with conditions of interest during the pre-intervention and post-intervention study periods. The clinicians were administered a survey once during the post-intervention period.
Participants by arm
| Arm | Count |
|---|---|
| Pre-Intervention: Patients Diagnosed With Conditions of Interest During Study Period This study evaluates changes in antibiotic prescribing practices following a stewardship intervention. The pre intervention time period defines the baseline cohort of patients diagnosed with one of the four target conditions, before exposure to the stewardship intervention. | 12,917 |
| Post-Intervention: Patients Diagnosed With Conditions of Interest During Study Period This study evaluates changes in antibiotic prescribing practices following a stewardship intervention. The post-intervention time period defines the cohort of patients diagnosed with one of the four target conditions, after exposure to the stewardship intervention. | 13,222 |
| Total | 26,139 |
Baseline characteristics
| Characteristic | Post-Intervention: Patients Diagnosed With Conditions of Interest During Study Period | Pre-Intervention: Patients Diagnosed With Conditions of Interest During Study Period | Total |
|---|---|---|---|
| Age, Categorical Adult Inpatients With Community Acquired Pneumonia <=18 years | 0 Participants | 0 Participants | 0 Participants |
| Age, Categorical Adult Inpatients With Community Acquired Pneumonia >=65 years | 148 Participants | 132 Participants | 280 Participants |
| Age, Categorical Adult Inpatients With Community Acquired Pneumonia Between 18 and 65 years | 182 Participants | 173 Participants | 355 Participants |
| Age, Categorical Adult Outpatients With Pharyngitis <=18 years | 49 Participants | 48 Participants | 97 Participants |
| Age, Categorical Adult Outpatients With Pharyngitis >=65 years | 556 Participants | 319 Participants | 875 Participants |
| Age, Categorical Adult Outpatients With Pharyngitis Between 18 and 65 years | 3159 Participants | 1665 Participants | 4824 Participants |
| Age, Categorical Pediatric Inpatients With Community Acquired Pneumonia <=18 years | 387 Participants | 413 Participants | 800 Participants |
| Age, Categorical Pediatric Inpatients With Community Acquired Pneumonia >=65 years | 0 Participants | 0 Participants | 0 Participants |
| Age, Categorical Pediatric Inpatients With Community Acquired Pneumonia Between 18 and 65 years | 0 Participants | 0 Participants | 0 Participants |
| Age, Categorical Pediatric Outpatients With Acute Otitis Media <=18 years | 8741 Participants | 10167 Participants | 18908 Participants |
| Age, Categorical Pediatric Outpatients With Acute Otitis Media >=65 years | 0 Participants | 0 Participants | 0 Participants |
| Age, Categorical Pediatric Outpatients With Acute Otitis Media Between 18 and 65 years | 0 Participants | 0 Participants | 0 Participants |
| Age, Categorical Total <=18 years | 9177 Participants | 10628 Participants | 19805 Participants |
| Age, Categorical Total >=65 years | 704 Participants | 451 Participants | 1155 Participants |
| Age, Categorical Total Between 18 and 65 years | 3341 Participants | 1838 Participants | 5179 Participants |
| Ethnicity (NIH/OMB) Adult Inpatients With Community Acquired Pneumonia Hispanic or Latino | 9 Participants | 9 Participants | 18 Participants |
| Ethnicity (NIH/OMB) Adult Inpatients With Community Acquired Pneumonia Not Hispanic or Latino | 320 Participants | 296 Participants | 616 Participants |
| Ethnicity (NIH/OMB) Adult Inpatients With Community Acquired Pneumonia Unknown or Not Reported | 1 Participants | 0 Participants | 1 Participants |
| Ethnicity (NIH/OMB) Adult Outpatients With Pharyngitis Hispanic or Latino | 185 Participants | 101 Participants | 286 Participants |
| Ethnicity (NIH/OMB) Adult Outpatients With Pharyngitis Not Hispanic or Latino | 3529 Participants | 1911 Participants | 5440 Participants |
| Ethnicity (NIH/OMB) Adult Outpatients With Pharyngitis Unknown or Not Reported | 50 Participants | 20 Participants | 70 Participants |
| Ethnicity (NIH/OMB) Pediatric Inpatients With Community Acquired Pneumonia Hispanic or Latino | 59 Participants | 69 Participants | 128 Participants |
| Ethnicity (NIH/OMB) Pediatric Inpatients With Community Acquired Pneumonia Not Hispanic or Latino | 317 Participants | 339 Participants | 656 Participants |
| Ethnicity (NIH/OMB) Pediatric Inpatients With Community Acquired Pneumonia Unknown or Not Reported | 11 Participants | 5 Participants | 16 Participants |
| Ethnicity (NIH/OMB) Pediatric Outpatients With Acute Otitis Media Hispanic or Latino | 671 Participants | 710 Participants | 1381 Participants |
| Ethnicity (NIH/OMB) Pediatric Outpatients With Acute Otitis Media Not Hispanic or Latino | 7854 Participants | 9339 Participants | 17193 Participants |
| Ethnicity (NIH/OMB) Pediatric Outpatients With Acute Otitis Media Unknown or Not Reported | 216 Participants | 118 Participants | 334 Participants |
| Ethnicity (NIH/OMB) Total Hispanic or Latino | 924 Participants | 889 Participants | 1813 Participants |
| Ethnicity (NIH/OMB) Total Not Hispanic or Latino | 12020 Participants | 11885 Participants | 23905 Participants |
| Ethnicity (NIH/OMB) Total Unknown or Not Reported | 278 Participants | 143 Participants | 421 Participants |
| Race (NIH/OMB) Adult Inpatients With Community Acquired Pneumonia American Indian or Alaska Native | 2 Participants | 0 Participants | 2 Participants |
| Race (NIH/OMB) Adult Inpatients With Community Acquired Pneumonia Asian | 8 Participants | 6 Participants | 14 Participants |
| Race (NIH/OMB) Adult Inpatients With Community Acquired Pneumonia Black or African American | 209 Participants | 203 Participants | 412 Participants |
| Race (NIH/OMB) Adult Inpatients With Community Acquired Pneumonia More than one race | 2 Participants | 3 Participants | 5 Participants |
| Race (NIH/OMB) Adult Inpatients With Community Acquired Pneumonia Native Hawaiian or Other Pacific Islander | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Adult Inpatients With Community Acquired Pneumonia Unknown or Not Reported | 20 Participants | 12 Participants | 32 Participants |
| Race (NIH/OMB) Adult Inpatients With Community Acquired Pneumonia White | 89 Participants | 81 Participants | 170 Participants |
| Race (NIH/OMB) Adult Outpatients With Pharyngitis American Indian or Alaska Native | 4 Participants | 1 Participants | 5 Participants |
| Race (NIH/OMB) Adult Outpatients With Pharyngitis Asian | 152 Participants | 74 Participants | 226 Participants |
| Race (NIH/OMB) Adult Outpatients With Pharyngitis Black or African American | 550 Participants | 312 Participants | 862 Participants |
| Race (NIH/OMB) Adult Outpatients With Pharyngitis More than one race | 40 Participants | 24 Participants | 64 Participants |
| Race (NIH/OMB) Adult Outpatients With Pharyngitis Native Hawaiian or Other Pacific Islander | 4 Participants | 3 Participants | 7 Participants |
| Race (NIH/OMB) Adult Outpatients With Pharyngitis Unknown or Not Reported | 290 Participants | 141 Participants | 431 Participants |
| Race (NIH/OMB) Adult Outpatients With Pharyngitis White | 2724 Participants | 1477 Participants | 4201 Participants |
| Race (NIH/OMB) Pediatric Inpatients With Community Acquired Pneumonia American Indian or Alaska Native | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Pediatric Inpatients With Community Acquired Pneumonia Asian | 23 Participants | 21 Participants | 44 Participants |
| Race (NIH/OMB) Pediatric Inpatients With Community Acquired Pneumonia Black or African American | 117 Participants | 130 Participants | 247 Participants |
| Race (NIH/OMB) Pediatric Inpatients With Community Acquired Pneumonia More than one race | 19 Participants | 19 Participants | 38 Participants |
| Race (NIH/OMB) Pediatric Inpatients With Community Acquired Pneumonia Native Hawaiian or Other Pacific Islander | 0 Participants | 1 Participants | 1 Participants |
| Race (NIH/OMB) Pediatric Inpatients With Community Acquired Pneumonia Unknown or Not Reported | 70 Participants | 71 Participants | 141 Participants |
| Race (NIH/OMB) Pediatric Inpatients With Community Acquired Pneumonia White | 158 Participants | 171 Participants | 329 Participants |
| Race (NIH/OMB) Pediatric Outpatients With Acute Otitis Media American Indian or Alaska Native | 0 Participants | 4 Participants | 4 Participants |
| Race (NIH/OMB) Pediatric Outpatients With Acute Otitis Media Asian | 210 Participants | 205 Participants | 415 Participants |
| Race (NIH/OMB) Pediatric Outpatients With Acute Otitis Media Black or African American | 949 Participants | 1056 Participants | 2005 Participants |
| Race (NIH/OMB) Pediatric Outpatients With Acute Otitis Media More than one race | 330 Participants | 314 Participants | 644 Participants |
| Race (NIH/OMB) Pediatric Outpatients With Acute Otitis Media Native Hawaiian or Other Pacific Islander | 8 Participants | 3 Participants | 11 Participants |
| Race (NIH/OMB) Pediatric Outpatients With Acute Otitis Media Unknown or Not Reported | 1157 Participants | 1204 Participants | 2361 Participants |
| Race (NIH/OMB) Pediatric Outpatients With Acute Otitis Media White | 6087 Participants | 7381 Participants | 13468 Participants |
| Race (NIH/OMB) Total American Indian or Alaska Native | 6 Participants | 5 Participants | 11 Participants |
| Race (NIH/OMB) Total Asian | 393 Participants | 306 Participants | 699 Participants |
| Race (NIH/OMB) Total Black or African American | 1825 Participants | 1701 Participants | 3526 Participants |
| Race (NIH/OMB) Total More than one race | 391 Participants | 360 Participants | 751 Participants |
| Race (NIH/OMB) Total Native Hawaiian or Other Pacific Islander | 12 Participants | 7 Participants | 19 Participants |
| Race (NIH/OMB) Total Unknown or Not Reported | 1537 Participants | 1428 Participants | 2965 Participants |
| Race (NIH/OMB) Total White | 9058 Participants | 9110 Participants | 18168 Participants |
| Sex: Female, Male Adult Inpatients With Community Acquired Pneumonia Female | 178 Participants | 168 Participants | 346 Participants |
| Sex: Female, Male Adult Inpatients With Community Acquired Pneumonia Male | 152 Participants | 137 Participants | 289 Participants |
| Sex: Female, Male Adult Outpatients With Pharyngitis Female | 2709 Participants | 1436 Participants | 4145 Participants |
| Sex: Female, Male Adult Outpatients With Pharyngitis Male | 1055 Participants | 596 Participants | 1651 Participants |
| Sex: Female, Male Pediatric Inpatients With Community Acquired Pneumonia Female | 195 Participants | 204 Participants | 399 Participants |
| Sex: Female, Male Pediatric Inpatients With Community Acquired Pneumonia Male | 192 Participants | 209 Participants | 401 Participants |
| Sex: Female, Male Pediatric Outpatients With Acute Otitis Media Female | 4132 Participants | 4714 Participants | 8846 Participants |
| Sex: Female, Male Pediatric Outpatients With Acute Otitis Media Male | 4609 Participants | 5453 Participants | 10062 Participants |
| Sex: Female, Male Total Female | 7215 Participants | 6522 Participants | 13737 Participants |
| Sex: Female, Male Total Male | 6007 Participants | 6395 Participants | 12402 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 0 / 0 | 0 / 0 |
| other Total, other adverse events | 0 / 0 | 0 / 0 |
| serious Total, serious adverse events | 0 / 0 | 0 / 0 |
Outcome results
Primary
Guideline-concordant Antibiotic Use for Adults With Community-acquired Pneumonia
Count of participants with community-acquired pneumonia with guideline-concordant antibiotic use for all three metrics (decision to prescribe an antibiotic, antibiotic choice, and antibiotic duration). The count of participants with community-acquired pneumonia with guideline-concordant antibiotic use for all three metrics was divided by the total number of participants with community-acquired pneumonia to generate the percentage of participants receiving guideline-concordant antibiotic use for all three metrics. These proportions were compared for the group of participants in the pre intervention period (1 year) and the post intervention period (1 year). There were not individual participant level measures for this outcome.
Time frame: Pre-intervention and post-intervention, up to 2 years
Population: Data for adults with community-acquired pneumonia only
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Pre-Intervention: Patients Diagnosed With Conditions of Interest During Study Period | Guideline-concordant Antibiotic Use for Adults With Community-acquired Pneumonia | 204 Participants |
| Post-Intervention: Patients Diagnosed With Conditions of Interest During Study Period | Guideline-concordant Antibiotic Use for Adults With Community-acquired Pneumonia | 242 Participants |
Primary
Guideline-concordant Antibiotic Use for Adults With Pharyngitis
Count of participants with pharyngitis with guideline-concordant antibiotic use for all three metrics (decision to prescribe an antibiotic, antibiotic choice, and antibiotic duration). The count of participants with pharyngitis with guideline-concordant antibiotic use for all three metrics was divided by the total number of participants with pharyngitis to generate the percentage of participants receiving guideline-concordant antibiotic use for all three metrics. These proportions were compared for the group of participants in the pre intervention period (1 year) and the post intervention period (1 year). There were not individual participant level measures for this outcome.
Time frame: Pre-intervention and post-intervention, up to 2 years
Population: Data for adults with pharyngitis only
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Pre-Intervention: Patients Diagnosed With Conditions of Interest During Study Period | Guideline-concordant Antibiotic Use for Adults With Pharyngitis | 1458 Participants |
| Post-Intervention: Patients Diagnosed With Conditions of Interest During Study Period | Guideline-concordant Antibiotic Use for Adults With Pharyngitis | 2477 Participants |
Primary
Guideline-concordant Antibiotic Use for Children With Acute Otitis Media
Count of participants with acute otitis media with guideline-concordant antibiotic use for all three metrics (decision to prescribe an antibiotic, antibiotic choice, and antibiotic duration). The count of participants with acute otitis media with guideline-concordant antibiotic use for all three metrics was divided by the total number of participants with pediatric acute otitis media who were prescribed antibiotics to generate the percentage of participants receiving guideline-concordant antibiotic use for all three metrics. These proportions were compared for the group of participants in the pre intervention period (1 year) and the post intervention period (1 year). There were not individual participant level measures for this outcome.
Time frame: Pre-intervention and post-intervention, up to 2 years
Population: Note: this metric of guideline-concordant antibiotic use was measured using a denominator of those who were prescribed antibiotics (pre-intervention: 9,020 participants; post-intervention: 7,778 participants). The overall number of participants with acute otitis media (pre-intervention: 10,167 participants; post-intervention: 8,741 participants) was NOT used as the denominator for this reason.
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Pre-Intervention: Patients Diagnosed With Conditions of Interest During Study Period | Guideline-concordant Antibiotic Use for Children With Acute Otitis Media | 6154 Participants |
| Post-Intervention: Patients Diagnosed With Conditions of Interest During Study Period | Guideline-concordant Antibiotic Use for Children With Acute Otitis Media | 6287 Participants |
Primary
Guideline-concordant Antibiotic Use for Children With Community-acquired Pneumonia
Count of participants with pediatric community-acquired pneumonia with guideline-concordant antibiotic use for all three metrics (decision to prescribe an antibiotic, antibiotic choice, and antibiotic duration). The count of participants with pediatric community-acquired pneumonia with guideline-concordant antibiotic use for all three metrics was divided by the total number of participants with pediatric community-acquired pneumonia to generate the percentage of participants receiving guideline-concordant antibiotic use for all three metrics. These proportions were compared for the group of participants in the pre intervention period (1 year) and the post intervention period (1 year). There were not individual participant level measures for this outcome.
Time frame: Pre-intervention and post-intervention, up to 2 years
Population: Data for children with community-acquired pneumonia only
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Pre-Intervention: Patients Diagnosed With Conditions of Interest During Study Period | Guideline-concordant Antibiotic Use for Children With Community-acquired Pneumonia | 213 Participants |
| Post-Intervention: Patients Diagnosed With Conditions of Interest During Study Period | Guideline-concordant Antibiotic Use for Children With Community-acquired Pneumonia | 308 Participants |
Secondary
28-day Acute Otitis Media-related Outpatient Revisits (Emergency Department, Urgent Care, or Primary Care)
Count of participants with pediatric acute otitis media with a return visit in the outpatient setting (emergency department, urgent care, or primary care) for pediatric acute otitis media within 28 days of the index acute otitis media encounter. The count of participants with pediatric acute otitis media with a return visit in the outpatient setting was divided by the total number of participants with pediatric acute otitis media to generate the percentage of participants with a return visit in the outpatient setting.
Time frame: 28 days
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Pre-Intervention: Patients Diagnosed With Conditions of Interest During Study Period | 28-day Acute Otitis Media-related Outpatient Revisits (Emergency Department, Urgent Care, or Primary Care) | 891 Participants |
| Post-Intervention: Patients Diagnosed With Conditions of Interest During Study Period | 28-day Acute Otitis Media-related Outpatient Revisits (Emergency Department, Urgent Care, or Primary Care) | 756 Participants |
Secondary
28-day Community Acquired Pneumonia-related Outpatient Revisits (Emergency Department, Urgent Care, or Primary Care) in Children
Count of participants with pediatric community-acquired pneumonia with a return visit in the outpatient setting (emergency department, urgent care, or primary care) for pediatric community acquired pneumonia within 28 days of discharge following index hospitalization for pediatric community acquired pneumonia. The count of participants with pediatric community-acquired pneumonia with a return visit in the outpatient setting was divided by the total number of participants with pediatric community-acquired pneumonia to generate the percentage of participants with a return visit in the outpatient setting.
Time frame: 28 days
Population: Data for pediatric community acquired pneumonia only
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Pre-Intervention: Patients Diagnosed With Conditions of Interest During Study Period | 28-day Community Acquired Pneumonia-related Outpatient Revisits (Emergency Department, Urgent Care, or Primary Care) in Children | 13 Participants |
| Post-Intervention: Patients Diagnosed With Conditions of Interest During Study Period | 28-day Community Acquired Pneumonia-related Outpatient Revisits (Emergency Department, Urgent Care, or Primary Care) in Children | 20 Participants |
Secondary
28-day Mastoiditis or Intracranial Infection Admissions
Count of participants with a readmission for mastoiditis or intracranial infection within 28 days of the index encounter for pediatric acute otitis media. The count of participants with a readmission for mastoiditis or intracranial infection was divided by the total number of participants with pediatric acute otitis media to generate the percentage of participants with readmissions within 28 days of discharge following an index hospitalization for acute otitis media.
Time frame: 28 days
Population: Data for pediatric acute otitis media only
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Pre-Intervention: Patients Diagnosed With Conditions of Interest During Study Period | 28-day Mastoiditis or Intracranial Infection Admissions | 0 Participants |
| Post-Intervention: Patients Diagnosed With Conditions of Interest During Study Period | 28-day Mastoiditis or Intracranial Infection Admissions | 0 Participants |
Secondary
28-day Readmissions for Pediatric Community Acquired Pneumonia
Count of participants with a readmission for community-acquired pneumonia within 28 days of discharge following an index hospitalization for community-acquired pneumonia. The count of participants with a readmission for community-acquired pneumonia was divided by the total number of participants with community-acquired pneumonia to generate the percentage of participants with readmissions within 28 days of discharge following an index hospitalization for community-acquired pneumonia.
Time frame: 28 days
Population: Data for pediatric community acquired pneumonia only
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Pre-Intervention: Patients Diagnosed With Conditions of Interest During Study Period | 28-day Readmissions for Pediatric Community Acquired Pneumonia | 8 Participants |
| Post-Intervention: Patients Diagnosed With Conditions of Interest During Study Period | 28-day Readmissions for Pediatric Community Acquired Pneumonia | 14 Participants |
Secondary
30-day Community Acquired Pneumonia-related Outpatient Revisits (Emergency Department, Urgent Care, or Primary Care) in Adults
Count of participants with community-acquired pneumonia with a return visit in the outpatient setting (emergency department, urgent care, or primary care) for community acquired pneumonia within 30 days of discharge following index hospitalization for adult community acquired pneumonia. The count of participants with community-acquired pneumonia with a return visit in the outpatient setting was divided by the total number of participants with community-acquired pneumonia to generate the percentage of participants with a return visit in the outpatient setting.
Time frame: 30 days
Population: Data for adults with community acquired pneumonia only
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Pre-Intervention: Patients Diagnosed With Conditions of Interest During Study Period | 30-day Community Acquired Pneumonia-related Outpatient Revisits (Emergency Department, Urgent Care, or Primary Care) in Adults | 0 Participants |
| Post-Intervention: Patients Diagnosed With Conditions of Interest During Study Period | 30-day Community Acquired Pneumonia-related Outpatient Revisits (Emergency Department, Urgent Care, or Primary Care) in Adults | 0 Participants |
Secondary
30-day Deep Neck Space Infection Admission
Count of participants with a readmission for deep neck space infection within 30 days of index encounter for pharyngitis. The count of participants with a readmission for deep neck space infection was divided by the total number of participants with adult pharyngitis to generate the percentage of participants with readmissions for deep neck space infection within 30 days of index encounter for pharyngitis.
Time frame: 30 days
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Pre-Intervention: Patients Diagnosed With Conditions of Interest During Study Period | 30-day Deep Neck Space Infection Admission | 0 Participants |
| Post-Intervention: Patients Diagnosed With Conditions of Interest During Study Period | 30-day Deep Neck Space Infection Admission | 1 Participants |
Secondary
30-day Pharyngitis Outpatient Revisits (Emergency Department, Urgent Care, or Primary Care) in Adults
Count of participants with adult pharyngitis with a return visit in the outpatient setting (emergency department, urgent care, or primary care) for pharyngitis within 30 days of discharge following index hospitalization for adult pharyngitis. The count of participants with pharyngitis with a return visit in the outpatient setting was divided by the total number of participants with pharyngitis to generate the percentage of participants with a return visit in the outpatient setting.
Time frame: 30 days
Population: Data for Adult Pharyngitis only
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Pre-Intervention: Patients Diagnosed With Conditions of Interest During Study Period | 30-day Pharyngitis Outpatient Revisits (Emergency Department, Urgent Care, or Primary Care) in Adults | 291 Participants |
| Post-Intervention: Patients Diagnosed With Conditions of Interest During Study Period | 30-day Pharyngitis Outpatient Revisits (Emergency Department, Urgent Care, or Primary Care) in Adults | 578 Participants |
Secondary
30-day Readmissions for Community Acquired Pneumonia in Adults
Count of participants with a readmission for community-acquired pneumonia within 30 days of discharge following an index hospitalization for community-acquired pneumonia. The count of participants with a readmission for community-acquired pneumonia was divided by the total number of participants with community-acquired pneumonia to generate the percentage of participants with readmissions within 30 days of discharge following an index hospitalization for community-acquired pneumonia.
Time frame: 30 days
Population: Data for adults with community acquired pneumonia only
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Pre-Intervention: Patients Diagnosed With Conditions of Interest During Study Period | 30-day Readmissions for Community Acquired Pneumonia in Adults | 13 Participants |
| Post-Intervention: Patients Diagnosed With Conditions of Interest During Study Period | 30-day Readmissions for Community Acquired Pneumonia in Adults | 6 Participants |
Secondary
Guideline-concordant Antibiotic Choice Adult Pharyngitis
Count of participants with adult pharyngitis with guideline-concordant antibiotic use for antibiotic choice. The count of participants with pharyngitis with guideline-concordant antibiotic use for this metric was divided by the total number of participants with pharyngitis to generate the percentage of participants receiving guideline-concordant antibiotic use for antibiotic choice. These proportions were compared for the group of participants in the pre intervention period (1 year) and the post intervention period (1 year). There were not individual participant level measures for this outcome.
Time frame: Pre-intervention and post-intervention, up to 2 years
Population: Note: this metric of guideline-concordant antibiotic use was measured using a denominator of those who were prescribed antibiotics for adult pharyngitis (pre-intervention: 32 participants; post-intervention: 175 participants). The overall number of participants with adult pharyngitis (pre-intervention: 2,032 participants; post-intervention: 3,764 participants) was NOT used as the denominator for this reason.
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Pre-Intervention: Patients Diagnosed With Conditions of Interest During Study Period | Guideline-concordant Antibiotic Choice Adult Pharyngitis | 27 Participants |
| Post-Intervention: Patients Diagnosed With Conditions of Interest During Study Period | Guideline-concordant Antibiotic Choice Adult Pharyngitis | 160 Participants |
Secondary
Guideline-concordant Antibiotic Choice for Adults Hospitalized With Community Acquired Pneumonia
Count of participants with community-acquired pneumonia with guideline-concordant antibiotic use for antibiotic choice. The count of participants with community-acquired pneumonia with guideline-concordant antibiotic use for this metric was divided by the total number of participants with community-acquired pneumonia to generate the percentage of participants receiving guideline-concordant antibiotic use for antibiotic choice. These proportions were compared for the group of participants in the pre intervention period (1 year) and the post intervention period (1 year). There were not individual participant level measures for this outcome.
Time frame: Pre-intervention and post-intervention, up to 2 years
Population: Data for adults hospitalized with community acquired pneumonia only
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Pre-Intervention: Patients Diagnosed With Conditions of Interest During Study Period | Guideline-concordant Antibiotic Choice for Adults Hospitalized With Community Acquired Pneumonia | 268 Participants |
| Post-Intervention: Patients Diagnosed With Conditions of Interest During Study Period | Guideline-concordant Antibiotic Choice for Adults Hospitalized With Community Acquired Pneumonia | 302 Participants |
Secondary
Guideline-concordant Antibiotic Choice for Pediatric Acute Otitis Media
Count of participants with pediatric acute otitis media with guideline-concordant antibiotic use for antibiotic choice. The count of participants with pediatric acute otitis media visits with guideline-concordant antibiotic use for this metric was divided by the total number of participants with pediatric acute otitis media who were prescribed antibiotics to generate the percentage of participants receiving guideline-concordant antibiotic use for antibiotic choice. These proportions were compared for the group of participants in the pre intervention period (1 year) and the post intervention period (1 year). There were not individual participant level measures for this outcome.
Time frame: Pre-intervention and post-intervention, up to 2 years
Population: Data for pediatric acute otitis media only
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Pre-Intervention: Patients Diagnosed With Conditions of Interest During Study Period | Guideline-concordant Antibiotic Choice for Pediatric Acute Otitis Media | 7498 Participants |
| Post-Intervention: Patients Diagnosed With Conditions of Interest During Study Period | Guideline-concordant Antibiotic Choice for Pediatric Acute Otitis Media | 6828 Participants |
Secondary
Guideline-concordant Antibiotic Choice for Pediatric Community Acquired Pneumonia
Count of participants with pediatric community-acquired pneumonia with guideline-concordant antibiotic use for antibiotic choice. The count of participants with pediatric community-acquired pneumonia with guideline-concordant antibiotic use for this metric was divided by the total number of participants with pediatric community-acquired pneumonia to generate the percentage of participants receiving guideline-concordant antibiotic use for antibiotic choice. These proportions were compared for the group of participants in the pre intervention period (1 year) and the post intervention period (1 year). There were not individual participant level measures for this outcome.
Time frame: Pre-intervention and post-intervention, up to 2 years
Population: Data for pediatric community acquired pneumonia only
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Pre-Intervention: Patients Diagnosed With Conditions of Interest During Study Period | Guideline-concordant Antibiotic Choice for Pediatric Community Acquired Pneumonia | 394 Participants |
| Post-Intervention: Patients Diagnosed With Conditions of Interest During Study Period | Guideline-concordant Antibiotic Choice for Pediatric Community Acquired Pneumonia | 362 Participants |
Secondary
Guideline-concordant Antibiotic Duration for Adult Pharyngitis
Count of participants with adult pharyngitis with guideline-concordant antibiotic use for antibiotic duration. The count of participants with pharyngitis with guideline-concordant antibiotic use for this metric was divided by the total number of participants with pharyngitis to generate the percentage of participants receiving guideline-concordant antibiotic use for antibiotic duration. These proportions were compared for the group of participants in the pre intervention period (1 year) and the post intervention period (1 year). There were not individual participant level measures for this outcome.
Time frame: Pre-intervention and post-intervention, up to 2 years
Population: Note: this metric of guideline-concordant antibiotic use was measured using a denominator of those who were prescribed antibiotics for adult pharyngitis (pre-intervention: 32 participants; post-intervention: 175 participants). The overall number of participants with adult pharyngitis (pre-intervention: 2,032 participants; post-intervention: 3,764 participants) was NOT used as the denominator for this reason.
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Pre-Intervention: Patients Diagnosed With Conditions of Interest During Study Period | Guideline-concordant Antibiotic Duration for Adult Pharyngitis | 31 Participants |
| Post-Intervention: Patients Diagnosed With Conditions of Interest During Study Period | Guideline-concordant Antibiotic Duration for Adult Pharyngitis | 175 Participants |
Secondary
Guideline-concordant Antibiotic Duration for Adults Hospitalized With Community Acquired Pneumonia
Count of participants with community-acquired pneumonia with guideline-concordant antibiotic use for antibiotic duration. The count of participants with community-acquired pneumonia with guideline-concordant antibiotic use for this metric was divided by the total number of participants with community-acquired pneumonia to generate the percentage of participants receiving guideline-concordant antibiotic use for antibiotic duration. These proportions were compared for the group of participants in the pre intervention period (1 year) and the post intervention period (1 year). There were not individual participant level measures for this outcome.
Time frame: Pre-intervention and post-intervention, up to 2 years
Population: Data for adults hospitalized with community acquired pneumonia only
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Pre-Intervention: Patients Diagnosed With Conditions of Interest During Study Period | Guideline-concordant Antibiotic Duration for Adults Hospitalized With Community Acquired Pneumonia | 230 Participants |
| Post-Intervention: Patients Diagnosed With Conditions of Interest During Study Period | Guideline-concordant Antibiotic Duration for Adults Hospitalized With Community Acquired Pneumonia | 261 Participants |
Secondary
Guideline-concordant Antibiotic Duration for Pediatric Acute Otitis Media
Count of participants with pediatric acute otitis media with guideline-concordant antibiotic use for antibiotic duration. The count of participants with pediatric acute otitis media with guideline-concordant antibiotic use for this metric was divided by the total number of participants with pediatric acute otitis media who were prescribed antibiotics to generate the percentage of participants receiving guideline-concordant antibiotic use for antibiotic duration. These proportions were compared for the group of participants in the pre intervention period (1 year) and the post intervention period (1 year). There were not individual participant level measures for this outcome.
Time frame: Pre-intervention and post-intervention, up to 2 years
Population: Data for pediatric acute otitis media only
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Pre-Intervention: Patients Diagnosed With Conditions of Interest During Study Period | Guideline-concordant Antibiotic Duration for Pediatric Acute Otitis Media | 7565 Participants |
| Post-Intervention: Patients Diagnosed With Conditions of Interest During Study Period | Guideline-concordant Antibiotic Duration for Pediatric Acute Otitis Media | 7281 Participants |
Secondary
Guideline-concordant Antibiotic Duration for Pediatric Community Acquired Pneumonia
Count of participants with pediatric community-acquired pneumonia with guideline-concordant antibiotic use for antibiotic duration. The count of participants with pediatric community-acquired pneumonia with guideline-concordant antibiotic use for this metric was divided by the total number of participants with pediatric community-acquired pneumonia to generate the percentage of participants receiving guideline-concordant antibiotic use for antibiotic duration. These proportions were compared for the group of participants in the pre intervention period (1 year) and the post intervention period (1 year). There were not individual participant level measures for this outcome.
Time frame: Pre-intervention and post-intervention, up to 2 years
Population: Data for pediatric community acquired pneumonia only
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Pre-Intervention: Patients Diagnosed With Conditions of Interest During Study Period | Guideline-concordant Antibiotic Duration for Pediatric Community Acquired Pneumonia | 221 Participants |
| Post-Intervention: Patients Diagnosed With Conditions of Interest During Study Period | Guideline-concordant Antibiotic Duration for Pediatric Community Acquired Pneumonia | 322 Participants |
Secondary
Guideline-concordant Decision to Not Prescribe Antibiotics for Adult Pharyngitis
Count of participants with adult pharyngitis with guideline-concordant antibiotic use for appropriate decision not to prescribe antibiotics. The count of participants with adult pharyngitis with an appropriate decision not to prescribe antibiotics was divided by the total number of participants with no antibiotics prescribed to generate the percentage of participants appropriately not prescribed antibiotics for pharyngitis. These proportions were compared for the group of participants in the pre intervention period (1 year) and the post intervention period (1 year). There were not individual participant level measures for this outcome.
Time frame: Pre-intervention and post-intervention, up to 2 years
Population: Of note, only a subgroup of patients were assessed with this metric.
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Pre-Intervention: Patients Diagnosed With Conditions of Interest During Study Period | Guideline-concordant Decision to Not Prescribe Antibiotics for Adult Pharyngitis | 1432 Participants |
| Post-Intervention: Patients Diagnosed With Conditions of Interest During Study Period | Guideline-concordant Decision to Not Prescribe Antibiotics for Adult Pharyngitis | 2312 Participants |
Secondary
Guideline-concordant Decision to Not Prescribe Antibiotics for Pediatric Acute Otitis Media
Count of participants with pediatric acute otitis media with guideline-concordant antibiotic use for appropriate decision not to prescribe antibiotics. The count of participants with pediatric acute otitis media with an appropriate decision not to prescribe antibiotics was divided by the total number of participants with no antibiotics prescribed to generate the percentage of participants appropriately not prescribed antibiotics for acute otitis media. These proportions were compared for the group of participants in the pre intervention period (1 year) and the post intervention period (1 year). There were not individual participant level measures for this outcome.
Time frame: Pre-intervention and post-intervention, up to 2 years
Population: Of note, only a subgroup of patients were assessed with this metric.
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Pre-Intervention: Patients Diagnosed With Conditions of Interest During Study Period | Guideline-concordant Decision to Not Prescribe Antibiotics for Pediatric Acute Otitis Media | 284 Participants |
| Post-Intervention: Patients Diagnosed With Conditions of Interest During Study Period | Guideline-concordant Decision to Not Prescribe Antibiotics for Pediatric Acute Otitis Media | 292 Participants |
Secondary
Guideline-concordant Decision to Prescribe Antibiotics for Adult Pharyngitis
Count of participants with pharyngitis for which the decision to prescribe an antibiotic was correct. The count of participants with pharyngitis for which the decision to prescribe an antibiotic was correct was divided by the total number of participants with pharyngitis to generate the percentage of participants for which the decision to prescribe an antibiotic was correct. These proportions were compared for the group of participants in the pre intervention period (1 year) and the post intervention period (1 year). There were not individual participant level measures for this outcome.
Time frame: Pre-intervention and post-intervention, up to 2 years
Population: This metric encapsulates patients who did and did not receive antibiotics.
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Pre-Intervention: Patients Diagnosed With Conditions of Interest During Study Period | Guideline-concordant Decision to Prescribe Antibiotics for Adult Pharyngitis | 1464 Participants |
| Post-Intervention: Patients Diagnosed With Conditions of Interest During Study Period | Guideline-concordant Decision to Prescribe Antibiotics for Adult Pharyngitis | 2492 Participants |
Secondary
Guideline-concordant Decision to Prescribe Antibiotics for Pediatric Acute Otitis Media
Count of participants with pediatric acute otitis media for which the decision to prescribe an antibiotic was correct. The count of participants with pediatric acute otitis media for which the decision to prescribe an antibiotic was correct was divided by the total number of participants with pediatric acute otitis media to generate the percentage of participants for which the decision to prescribe an antibiotic was correct. These proportions were compared for the group of participants in the pre intervention period (1 year) and the post intervention period (1 year). There were not individual participant level measures for this outcome.
Time frame: Pre-intervention and post-intervention, up to 2 years
Population: This metric encapsulates patients who did and did not receive antibiotics.
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Pre-Intervention: Patients Diagnosed With Conditions of Interest During Study Period | Guideline-concordant Decision to Prescribe Antibiotics for Pediatric Acute Otitis Media | 9935 Participants |
| Post-Intervention: Patients Diagnosed With Conditions of Interest During Study Period | Guideline-concordant Decision to Prescribe Antibiotics for Pediatric Acute Otitis Media | 8547 Participants |
Other Pre-specified
Acceptability of Intervention Measure - Inpatient
Acceptability is defined as how well the intervention was received by the prescribing clinicians. The acceptability of intervention measure is the full name of this scale. The acceptability of intervention scale consists of four questions, each with 5 possible responses (completely disagree, disagree, neither agree or disagree, agree, or completely agree) on a numeric 1-5 scale. These four subscores are summed to generate a total score, with possible scores ranging from 4-20. A higher score indicates that the intervention is more acceptable. There are no validated cutoffs for acceptability. The mean total score and standard deviation of the mean total score for all respondents are reported. The acceptability of intervention measure was assessed by a one time survey in the post-intervention time period.
Time frame: One time measure in the post intervention time period.
Population: The pre-intervention and post-intervention clinicians are the same people and this survey was administered to this group of individuals once during the post-intervention period.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Pre-Intervention: Patients Diagnosed With Conditions of Interest During Study Period | Acceptability of Intervention Measure - Inpatient | 17.2 units on a scale | Standard Deviation 3.5 |
Other Pre-specified
Acceptability of Intervention - Outpatient
Acceptability is defined as how well the intervention was received by the prescribing clinicians. The acceptability of intervention measure is the full name of this scale. The acceptability of intervention scale consists of four questions, each with 5 possible responses (completely disagree, disagree, neither agree or disagree, agree, or completely agree) on a numeric 1-5 scale. These four subscores are summed to generate a total score, with possible scores ranging from 4-20. A higher score indicates that the intervention is more acceptable. There are no validated cutoffs for acceptability. The mean total score and standard deviation of the mean total score for all respondents are reported. The acceptability of intervention measure was assessed by a one time survey in the post-intervention time period.
Time frame: One time measure in the post intervention time period
Population: The pre-intervention and post-intervention clinicians are the same people and this survey was administered to this group of individuals once during the post-intervention period.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Pre-Intervention: Patients Diagnosed With Conditions of Interest During Study Period | Acceptability of Intervention - Outpatient | 13.4 units on a scale | Standard Deviation 4.6 |
Other Pre-specified
Feasibility of Intervention Measure - Inpatient
Feasibility is defined as the extent to which the intervention can be carried out in the clinical setting. The feasibility of intervention measure is the full name of this scale. The feasibility of intervention scale consists of four questions, each with 5 possible responses (completely disagree, disagree, neither agree or disagree, agree, or completely agree) on a numeric 1-5 scale. These four subscores are summed to generate a total score, with possible scores ranging from 4-20. A higher score indicates that the intervention is more feasible. There are no validated cutoffs for feasibility. The mean total score and standard deviation of the mean total score for all respondents are reported. The feasibility of intervention measure was assessed by a one time survey in the post-intervention time period.
Time frame: One time measure in the post intervention time period
Population: The pre-intervention and post-intervention clinicians are the same people and this survey was administered to this group of individuals once during the post-intervention period.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Post-Intervention: Patients Diagnosed With Conditions of Interest During Study Period | Feasibility of Intervention Measure - Inpatient | 17.7 units on a scale | Standard Deviation 3.1 |
Other Pre-specified
Feasibility of Intervention - Outpatient
Feasibility is defined as the extent to which the intervention can be carried out in the clinical setting. The feasibility of intervention measure is the full name of this scale. The feasibility of intervention scale consists of four questions, each with 5 possible responses (completely disagree, disagree, neither agree or disagree, agree, or completely agree) on a numeric 1-5 scale. These four subscores are summed to generate a total score, with possible scores ranging from 4-20. A higher score indicates that the intervention is more feasible. There are no validated cutoffs for feasibility. The mean total score and standard deviation of the mean total score for all respondents are reported. The feasibility of intervention measure was assessed by a one time survey in the post-intervention time period.
Time frame: One time measure in the post intervention time period
Population: The pre-intervention and post-intervention clinicians are the same people and this survey was administered to this group of individuals once during the post-intervention period.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Pre-Intervention: Patients Diagnosed With Conditions of Interest During Study Period | Feasibility of Intervention - Outpatient | 15.7 units on a scale | Standard Deviation 3.1 |