Increasing Guideline-Concordant Durations of Antibiotic Therapy for Acute Otitis Media.
Increasing Guideline-Concordant Durations of Antibiotic Therapy for Acute Otitis Media.
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DOI：
10.1016/j.jpeds.2021.07.016
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发表时间：
2022-01
期刊：
影响因子：
--
通讯作者：
Jenkins TC
中科院分区：
文献类型：
--
作者：
Frost HM;Lou Y;Keith A;Byars A;Jenkins TC
比较两种干预措施在改善急性中耳炎（AOM）治疗指南一致持续时间方面的有效性。这是一项准实验混合方法分析，比较了捆绑式质量改进干预措施（包括个性化审计和反馈、教育和电子健康记录（EHR）变更）与仅EHR干预措施。该捆绑包于2020年1月至8月在3家儿科诊所实施，并在6家家庭医学诊所实施了仅电子健康记录干预。主要结局指标是为≥ 2岁的无并发症AOM儿童处方与机构指南一致的5天治疗持续时间。完成倾向评分匹配和差异中的差异分析（采用治疗的逆概率加权）。使用RE-AIM评估实施结果。平衡指标包括治疗失败和复发。从2019年2月到2020年8月，总共有1，017次AOM遭遇。在接受EHR单独干预的诊所中，指南一致性处方从14.4%增加到63.8%（差异=49.4%），在接受捆绑干预的诊所中，从10.6%增加到85.2%（差异=74.6%）。在调整后的分析中，捆绑式干预与EHR单独干预相比，指南一致性持续时间增加了26.4%（P <0.01）。提供者将EHR处方字段更改确定为最有用的组件。基线和两种干预之间的治疗失败率或复发率没有差异。两种干预措施均改善了抗生素指南一致持续时间的处方。捆绑式干预措施比仅使用电子健康记录的干预措施更能改善处方，并为供应商所接受。
To compare the effectiveness of two interventions in improving prescribing of guideline-concordant durations of therapy for acute otitis media (AOM). 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-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 RE-AIM. Balance measures included treatment failure and recurrence. In total, 1,017 encounters for AOM were included from February 2019-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. 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.
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影响因子：
12.7
作者：
Glasgow, RE;Vogt, TM;Boles, SM
通讯作者：
Boles, SM
影响因子：
4.5
作者：
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Jenkins, Timothy C.
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8
作者：
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影响因子：
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作者：
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通讯作者：
Hicks, Lauri A.
影响因子：
5.2
作者：
Deshpande, Abhishek;Pasupuleti, Vinay;Donskey, Curtis J.
通讯作者：
Donskey, Curtis J.