Impact of clinician feedback reports on antibiotic use in children hospitalized with community-acquired pneumonia

Kathleen Chiotos, Division of Critical Care Medicine, Department of Anesthesiology and Critical Care, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
Lauren Dutcher, Division of Infectious Diseases, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
Robert W. Grundmeier, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
Didien Meyahnwi, Clinical Futures, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
Ebbing Lautenbach, Division of Infectious Diseases, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
Melinda M. Neuhauser, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA.
Lauri A. Hicks, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA.
Keith W. Hamilton, Division of Infectious Diseases, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
Yun Li, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
Julia E. Szymczak, Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, Utah, USA.
Brandi M. Muller, Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, Utah, USA.
Morgan Congdon, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
Emily Kane, Division of General Pediatrics, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
Jessica Hart, Division of General Pediatrics, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
Levon Utidjian, Division of General Pediatrics, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
Leigh Cressman, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
Anne Jaskowiak-Barr, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
Jeffrey S. Gerber, Division of Infectious Diseases, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA.

Document Type

Article

Publication Title

Clinical infectious diseases : an official publication of the Infectious Diseases Society of America

Abstract

BACKGROUND: Feedback reports summarizing clinician performance are effective tools for improving antibiotic use in the ambulatory setting, but the effectiveness of feedback reports in the hospital setting is unknown. METHODS: Quasi-experimental study conducted between December 2021 and November 2023 within a pediatric health system measuring the impact of clinician feedback reports delivered by email and reviewed in a monthly meeting on appropriate antibiotic use in children hospitalized with community-acquired pneumonia (CAP). We used an interrupted time series analysis (ITSA) to estimate the immediate change and change over time in the proportion of CAP encounters adherent to validated metrics of antibiotic choice and duration, then used Poisson regression to estimate intervention effect as a rate ratio (RR). RESULTS: Preintervention, 213 of 413 (52%) encounters received the appropriate antibiotic choice and duration, which increased to 308 of 387 (80%) postintervention. The ITSA demonstrated an immediate 18% increase in the proportion of CAP encounters receiving both the appropriate antibiotic choice and duration (95% confidence interval, 3-33%), with no further change over time (-0.3% per month, 95% CI -2-2%). In the Poisson model adjusted for age, sex, race, season, site, and intensive care unit admission, the intervention was associated with a 32% increase in the rate of appropriate antibiotic choice and duration (RR 1.32, 95% confidence interval 1.12-1.56, P <0.01). No difference in length of stay or revisits were detected postintervention. CONCLUSION: The intervention was associated with an increase in clinician adherence to antibiotic choice and duration recommendations for children hospitalized with CAP.

DOI

10.1093/cid/ciae593

Publication Date

12-3-2024

Identifier

39656188 (pubmed); 10.1093/cid/ciae593 (doi); 7915722 (pii)

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