scholarly journals Interrupted time-series analysis to evaluate the impact of a behavioral change outpatient antibiotic stewardship intervention

2021 ◽  
Vol 1 (1) ◽  
Author(s):  
Brittany L. Morgan ◽  
Haylee Bettencourt ◽  
Larissa May
Keyword(s):  
Quality Improvement ◽  
Respiratory Infections ◽  
Eligible Patient ◽  
Inappropriate Prescribing ◽  
Interrupted Time Series ◽  
International Classification Of Diseases ◽  
Quality Improvement Intervention ◽  
Interrupted Time Series Analysis ◽  
The Impact ◽  
Improvement Intervention

Abstract Objective: We evaluated the effect of a behaviorally enhanced quality improvement intervention in reducing the number of antibiotic prescriptions written for antibiotic nonresponsive acute respiratory infections (ARIs). A secondary objective was identifying whether a reduction in inappropriate antibiotic prescriptions, if present, persisted after the immediate implementation of the intervention. Design: Nonrandomized, quasi-experimental study conducted from January 2017 through February 2020. Setting: University of California, Davis Health outpatient clinics. In total, 21 pediatric, family, and internal medicine practices in 10 cities and towns were included. Patients: Patients evaluated by a participating physician at an enrolled practice site during the study period with diagnoses (primary and secondary) from the International Classification of Diseases, Tenth Revision codes consistent with antibiotic nonresponsive ARI diagnoses. Intervention: A behaviorally enhanced quality improvement intervention to reduce inappropriate prescribing for antibiotic nonresponsive ARI. Results: In total, 63,028 eligible patient visits across 21 locations were included in the analysis. The most frequently prescribed antibiotic for antibiotic nonresponsive ARI was azithromycin (n = 3,551), followed by amoxicillin (n = 924). Overall, the intervention was associated with an immediate 46% reduction in antibiotic prescriptions for antibiotic nonresponsive ARI (P = .001) following the intervention. We detected no significant change in the month-to-month trend after the intervention was implemented (P = .87), indicating that the reduction was sustained throughout the postintervention period. Conclusion: Our findings demonstrate that a behaviorally enhanced quality improvement intervention to reduce inappropriate prescribing for antibiotic nonresponsive ARI in ambulatory care encounters was successful in reducing potentially inappropriate prescriptions for presumed antibiotic nonresponsive ARI.

scholarly journals Interrupted Time-Series Analysis to Evaluate the Impact of a Behavioral Change Outpatient Antibiotic Stewardship Intervention

2021 ◽  
Vol 1 (S1) ◽  
pp. s15-s16
Author(s):  
Brittany Morgan ◽  
Larissa May ◽  
Haylee Bettencourt
Keyword(s):  
Quality Improvement ◽  
Antibiotic Stewardship ◽  
Respiratory Infections ◽  
Inappropriate Prescribing ◽  
The United States ◽  
Quality Improvement Intervention ◽  
Antibiotic Prescribing ◽  
The Impact ◽  
Improvement Intervention ◽  
Inappropriate Prescriptions

Background: The Centers for Disease Control and Prevention (CDC) estimates that outpatient settings account for 85%–90% of antibiotic prescriptions in the United States, and ~30% of those prescriptions are unnecessary. One of the most common examples of inappropriate prescribing is for viral upper respiratory infections (URIs). Up to 50% of prescriptions written for URIs are deemed inappropriate, making it an important focus for Antibiotic Stewardship programs. In this study, we evaluated the effect of a behaviorally enhanced quality improvement intervention in reducing inappropriate antibiotic prescribing for viral URIs. Methods: A quasi-experimental study assessed the effects of an Antibiotic Stewardship intervention on antibiotic prescribing for viral URIs. The outcome of interest was a change in the number of antibiotics prescribed at each participating clinic over a 1-year preimplementation period and a 2-year postimplementation period. Time trends were analyzed using segmented regression analysis, and a stepped wedge design was used to account for intervention roll-out across clinics. Results: From 2017 to 2020, there were 63,028 patient visits in 21 clinic locations. Antibiotics were prescribed an average of 11.5% and 5.8% of visits during the pre- and postimplementation periods, respectively. The most frequently prescribed antibiotic over the study period was azithromycin (n = 3,551), followed by amoxicillin (n = 924). Overall, the intervention was associated with a 46% reduction in antibiotic prescriptions or 0.54 times (P = .001) as many inappropriate antibiotics prescribed as before the intervention. There was no significant change in the month-to-month trend in inappropriate prescriptions after the intervention was implemented (P = .87). Conclusions: Our study demonstrates that a behaviorally enhanced quality improvement intervention to reduce inappropriate prescribing for URI in ambulatory care encounters was successful in reducing potentially inappropriate prescriptions for presumed viral respiratory infections.Funding: NoDisclosures: None

A Multimodal Intervention to Reduce Urinary Catheter Use and Associated Infection at a Veterans Affairs Medical Center

2013 ◽  
Vol 34 (6) ◽  
pp. 631-633 ◽  
Author(s):  
Brady L. Miller ◽  
Sarah L. Krein ◽  
Karen E. Fowler ◽  
Karen Belanger ◽  
Debbie Zawol ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Urinary Catheter ◽  
Medical Center ◽  
Veterans Affairs ◽  
Quality Improvement Intervention ◽  
Tract Infections ◽  
The Impact ◽  
Improvement Intervention

We assessed the impact of a quality improvement intervention to reduce urinary catheter use and associated urinary tract infections (UTIs) at a single hospital. After implementation, UTIs were reduced by 39% (P = .04). Additionally, we observed a slight decrease in catheter use and the number of catheters without an appropriate indication.

scholarly journals Developing and Evaluating a Quality Improvement Intervention to Facilitate Patient Navigation in the Accountable Health Communities Model

2021 ◽  
Vol 8 ◽  
Author(s):  
Jennifer L. Holcomb ◽  
Gretchen H. Walton ◽  
Itunu O. Sokale ◽  
Gayla M. Ferguson ◽  
Vanessa R. Schick ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Technical Assistance ◽  
Patient Navigation ◽  
Social Needs ◽  
Quality Improvement Intervention ◽  
Research Protocol ◽  
Multi Level ◽  
Health Communities ◽  
The Impact ◽  
Improvement Intervention

Introduction: The Accountable Health Communities (AHC) Model was designed to address the health-related social needs of Centers for Medicare & Medicaid Services beneficiaries. Bridge organizations across the AHC Model have identified lack of technical assistance and peer planning as potential barriers to Model success, particularly around patient navigation. The technical assistance and peer planning literature lacks an organizing, conceptual framework, but implementation science frameworks could serve as useful guides. The Strengthening Peer AHC Navigation (SPAN) research protocol seeks to fill this gap and will apply three implementation science frameworks, Consolidated Framework for Implementation Research, Intervention Mapping, and the Expert Recommendations for Implementing Change compilation, to develop a multi-level quality improvement intervention and evaluate the impact of peer planning on Model outcomes. The aims of the SPAN study are to implement and evaluate a novel multi-level quality improvement intervention to improve AHC implementation and navigation milestones through structured peer planning and to provide successful technical assistance for the AHC Model.Methods and Analysis: The quality improvement intervention is outlined in four Tasks: (1) Assessment – to conduct an assessment of each bridge organization's current implementation, needs, and readiness in AHC Model navigation activities; (2) Planning – to engage in a peer planning approach to build capacity for AHC Model navigation activities; (3) Implementation with technical assistance – Co-creation of a quality improvement protocol for AHC Model navigation activities; and (4) Evaluation – measure the impact of the peer planning and technical assistance approach. Alongside the development and implementation of the quality improvement intervention, this protocol describes a mixed method, convergent parallel study design which will be used to evaluate whether the quality improvement intervention will lead to better outcomes. Tasks will be replicated with five bridge organizations participating in the AHC Model.Discussion: This research protocol provides a framework that can be used to conduct structured peer planning with technical assistance for social needs programs. This study will provide data on both implementation and outcomes which eventually may impact healthcare cost and utilization.

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