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Development and validation of antibiotic stewardship metrics for outpatient respiratory tract diagnoses and association of provider characteristics with inappropriate prescribing

Published online by Cambridge University Press:  02 June 2021

Kathleen O. Degnan ,
Valerie Cluzet ,
Michael Z. David ,
Lauren Dutcher ,
Leigh Cressman ,
Ebbing Lautenbach ,
Keith W. Hamilton Open the ORCID record for Keith W. Hamilton [Opens in a new window]  and
for the CDC Prevention Epicenters Program
Kathleen O. Degnan
Affiliation:
Division of Infectious Diseases, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
Valerie Cluzet
Affiliation:
Health Quest Medical Practice, PC, Poughkeepsie, New York
Michael Z. David
Affiliation:
Division of Infectious Diseases, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania
Lauren Dutcher
Affiliation:
Division of Infectious Diseases, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania
Leigh Cressman
Affiliation:
Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania
Ebbing Lautenbach
Affiliation:
Division of Infectious Diseases, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania
Keith W. Hamilton*
Affiliation:
Division of Infectious Diseases, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
*
Author for correspondence: Keith W. Hamilton, E-mail: keith.hamilton@pennmedicine.upenn.edu
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Abstract

Objective:

To determine metrics and provider characteristics associated with inappropriate antibiotic prescribing for respiratory tract diagnoses (RTDs).

Design:

Retrospective cohort study.

Setting:

Primary care practices in a university health system.

Participants:

Patients seen by an attending physician or advanced practice provider (APP) at their primary care office visit with International Classification of Disease, Tenth Revision, Clinical Modification (ICD-10-CM)–coded RTDs.

Methods:

Medical records were reviewed for 1,200 randomly selected office visits in which an antibiotic was prescribed to determine appropriateness. Based on this gold standard, metrics and provider characteristics associated with inappropriate antibiotic prescribing were determined.

Results:

Overall, 69% of antibiotics were inappropriate. Metrics utilizing prespecified RTDs most strongly associated with inappropriate prescribing were (1) proportion prescribing for RTDs for which antibiotics are almost never required (eg, bronchitis) and (2) proportion prescribing for any RTD. Provider characteristics associated with inappropriate antibiotic prescribing were APP versus physician (72% vs 58%; P = .02), family medicine versus internal medicine (76% vs 63%; P = .01), board certification 1997 or later versus board certification before 1997 (75% vs 63%; P = .02), nonteaching versus teaching practice (73% vs 51%; P < .01), and nonurban vs urban practice (77% vs 57%; P < .01).

Conclusions:

Metrics utilizing proportion prescribing for RTDs for which antibiotics are almost never required and proportion prescribing for any RTD were most strongly associated with inappropriate prescribing. APPs and clinicians with family medicine training, with board certification 1997 or later, and who worked in nonteaching or nonurban practices had higher proportions of inappropriate prescribing. These findings could inform design of interventions to improve prescribing and could represent an efficient way to track inappropriate prescribing.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 43 , Issue 1 , January 2022 , pp. 56 - 63
Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

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