Variation in Antibiotic Prescribing Across a Pediatric Primary Care Network

Objectives. To identify associations between patient race and annual chlamydia screening among adolescent females. Methods. We performed a retrospective cohort study of females aged 15 to 19 years in a 31-clinic pediatric primary care network in Pennsylvania and New Jersey from 2015 through 2019. Using mixed-effect logistic regressions, we estimated associations between annual chlamydia screening and patient (race/ethnicity, age, previous chlamydia screening and infection, insurance type) and clinic (size, setting) characteristics. We decomposed potential effects of clinician’s implicit racial bias and screening, using covariates measuring the proportion of Black patients in each clinician’s practice. Results. There were 68 935 well visits among 37 817 females, who were 28.8% Black and 25.8% Medicaid insured. The mean annual chlamydia screening rate was 11.1%. Black females had higher odds of screening (adjusted odds ratio [AOR] = 1.67; 95% confidence interval [CI] = 1.51, 1.84) than did White females. In the clinician characteristics model, individual clinicians were more likely to screen their Black versus non-Black patients (AOR = 1.88; 95% CI = 1.65, 2.15). Conclusions. Racial bias may affect screening practices and should be addressed in future interventions, given the critical need to increase population-level chlamydia screening.(Am J Public Health. 2022;112(1):135–143. https://doi.org/10.2105/AJPH.2021.306498 )

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Measuring the Impact of Electronic Health Record Adoption on Charge Capture

Medical Care Research and Review ◽

10.1177/1077558716659408 ◽

2016 ◽

Vol 74 (5) ◽

pp. 582-594 ◽

Cited By ~ 4

Author(s):

Nicholas Edwardson ◽

Bita A. Kash ◽

Ramkumar Janakiraman

Keyword(s):

Primary Care ◽

Electronic Health Record ◽

Fixed Effects ◽

Pediatric Primary Care ◽

Health Record ◽

Care Network ◽

Collection Data ◽

Ehr Adoption ◽

Electronic Health ◽

The Impact

We examine the impact of electronic health record (EHR) adoption on charge capture—the ability of providers to properly ensure that billable services are accurately recorded and reported for payment. Drawing on billing and practice management data from a large, integrated pediatric primary care network that was previously a paper-based organization, monthly encounter, charge, and collection data were collected from 2008 through 2013. Two-level fixed effects models were built to test the impact of EHR adoption on charge capture. The introduction of the EHR to the pediatric primary care network was independently associated with an $11.09 increase in average per patient charges, an $11.49 increase in average per patient collections, and an improvement in physicians’ charge-to-collection ratios. Despite high initial outlays and operating costs related to EHR adoption, these results suggest organizations may recoup many of these costs over the long term.

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The impact of the COVID-19 pandemic on STI/HIV testing among adolescents in a large pediatric primary care network

Sexually Transmitted Diseases ◽

10.1097/olq.0000000000001427 ◽

2021 ◽

Vol Publish Ahead of Print ◽

Author(s):

Stephen Bonett ◽

Danielle Petsis ◽

Nadia Dowshen ◽

José Bauermeister ◽

Sarah M. Wood

Keyword(s):

Primary Care ◽

Hiv Testing ◽

Pediatric Primary Care ◽

Care Network ◽

The Impact

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Ambulatory Subspecialty Visits in a Large Pediatric Primary Care Network

Health Services Research ◽

10.1111/j.1475-6773.2012.01391.x ◽

2012 ◽

Vol 47 (4) ◽

pp. 1755-1769 ◽

Cited By ~ 8

Author(s):

Louis Vernacchio ◽

Jennifer M. Muto ◽

Gregory Young ◽

Wanessa Risko

Keyword(s):

Primary Care ◽

Pediatric Primary Care ◽

Care Network

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Variability in the Diagnosis and Treatment of Group A Streptococcal Pharyngitis by Primary Care Pediatricians

Infection Control and Hospital Epidemiology ◽

10.1017/s0899823x00194036 ◽

2014 ◽

Vol 35 (S3) ◽

pp. S79-S85 ◽

Cited By ~ 3

Author(s):

Julie L. Fierro ◽

Priya A. Prasad ◽

A. Russell Localio ◽

Robert W. Grundmeier ◽

Richard C. Wasserman ◽

...

Keyword(s):

Primary Care ◽

Streptococcal Pharyngitis ◽

Diagnosis And Treatment ◽

Pediatric Primary Care ◽

Antibiotic Prescribing ◽

Acute Pharyngitis ◽

Significant Variability ◽

Group A ◽

Care Practices ◽

Primary Care Practices

Objective.To compare practice patterns regarding the diagnosis and management of streptococcal pharyngitis across pediatric primary care practices.Design.Retrospective cohort study.Setting.All encounters to 25 pediatric primary care practices sharing an electronic health record.Methods.Streptococcal pharyngitis was defined by an International Classification of Diseases, Ninth Revision code for acute pharyngitis, positive laboratory test, antibiotic prescription, and absence of an alternative bacterial infection. Logistic regression models standardizing for patient-level characteristics were used to compare diagnosis, testing, and broad-spectrum antibiotic treatment for children with pharyngitis across practices. Fixed-effects models and likelihood ratio tests were conducted to analyze within-practice variation.Results.Of 399,793 acute encounters in 1 calendar year, there were 52,658 diagnoses of acute pharyngitis, including 12,445 diagnoses of streptococcal pharyngitis. After excluding encounters by patients with chronic conditions and standardizing for age, sex, insurance type, and race, there was significant variability across and within practices in the diagnosis and testing for streptococcal pharyngitis. Excluding patients with antibiotic allergies or prior antibiotic use, off-guideline antibiotic prescribing for confirmed group A streptococcal pharyngitis ranged from 1% to 33% across practices (P < .001). At the clinician level, 13 of 25 sites demonstrated significant within-practice variability in off-guideline antibiotic prescribing (P ≤ .05). Only 18 of the 222 clinicians in the network accounted for half of all off-guideline antibiotic prescribing.Conclusions.Significant variability in the diagnosis and treatment of pharyngitis exists across and within pediatric practices, which cannot be explained by relevant clinical or demographic factors. Our data support clinician-targeted interventions to improve adherence to prescribing guidelines for this common condition.

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162. The Impact of the COVID-19 Pandemic on Antibiotic Prescribing in Pediatric Primary Care

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab466.162 ◽

2021 ◽

Vol 8 (Supplement_1) ◽

pp. S97-S98

Author(s):

Lauren Dutcher ◽

Yun Li ◽

Giyoung Lee ◽

Robert Grundmeier ◽

Keith W Hamilton ◽

...

Keyword(s):

Primary Care ◽

Urinary Tract ◽

Soft Tissue ◽

Respiratory Tract ◽

Respiratory Tract Infections ◽

Interrupted Time Series ◽

Pediatric Primary Care ◽

Antibiotic Prescribing ◽

Tract Infections ◽

The Impact

Abstract Background With the onset of the coronavirus disease 2019 (COVID-19) pandemic, pediatric primary care delivery changed rapidly. Prior studies have demonstrated a reduction in ambulatory encounters and antibiotic prescriptions with the pandemic onset; however, the durability of these reductions in pediatric primary care in the United States has not been assessed. Methods We conducted a retrospective cohort study to assess the impact of the COVID-19 pandemic and associated public health measures (e.g. social distancing, masking, school closures, and increased availability of telemedicine) on antibiotic prescribing and encounter volume in 27 pediatric primary care practices, and the duration of these changes. Patients under age 19 with an encounter from January 1, 2018 through December 31, 2020 were included. The primary outcome was monthly antibiotic prescriptions per 1000 patients, in the overall population and a subset of encounters with infectious diagnoses, including respiratory tract infections (RTIs). Interrupted time series (ITS) analysis was performed. Results There were 60,562 total antibiotic prescriptions from April to December in 2019 and 14,605 antibiotic prescriptions during the same months in 2020, a 76% reduction. The reduction in RTI encounter prescriptions accounted for 91.5% of the overall reduction in prescriptions from 2019 to 2020. Using ITS analysis, there was an immediate decrease from 31.6 to 7.4 prescriptions/1000 patients (predicted means) in April 2020 (-24.2 prescriptions/1000 patients; 95% CI: -31.9, -16.4) (Figures 1 and 2). This was followed by a stable rate of antibiotic prescriptions that remained flat through December 2020. For RTI encounters, a similar pattern was seen, with a decrease by 21.8 prescriptions/1000 patients; 95% CI: -29.5, -14.2) (Figures 1 and 2). Encounter volume also decreased immediately, and while overall encounter volume began returning to a pre-pandemic baseline volume toward the end of the study period, RTI encounter volume remained persistently lower through December 2020 (Figure 3). Figure 1. Antibiotic prescriptions per 1000 patients prescribed by month from January 2018 to December 2020, overall and for disease-specific subgroups RTI = respiratory tract infection; UTI = urinary tract infection; SSTI = skin and soft tissue infection. Months are numbered sequentially, starting with January (number 1). Dashed line indicates first full month of the pandemic, April 2020. Interrupted time series analysis for antibiotic prescriptions per 1000 patients by month from January 2018 to December 2020 for (A) all antibiotics as well as antibiotics prescribed at encounters with (B) respiratory tract infections (RTIs), (C) urinary tract infections (UTIs), and (D) skin and soft tissue infections (SSTIs) Intervention starts in April 2020 (dashed line). Months are numbered sequentially, starting with January (number 1). Dashed line indicates first full month of the pandemic, April 2020. Antibiotic prescriptions per 1000 billed encounters by month from January 2018 to December 2020 for (A) all encounters, as well as antibiotics prescribed at encounters with (B) respiratory tract infections (RTIs), (C) urinary tract infections (UTIs), and (D) skin and soft tissue infections (SSTIs) Months are numbered sequentially, starting with January (number 1). Conclusion Dramatic reductions in antibiotic prescribing in pediatric primary care during the COVID-19 pandemic were sustained through 2020, primarily driven by reductions in RTI encounters. Disclosures All Authors: No reported disclosures

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COVID-19 and Antibiotic Prescribing in Pediatric Primary Care

PEDIATRICS ◽

10.1542/peds.2021-053079 ◽

2022 ◽

Author(s):

Lauren Dutcher ◽

Yun Li ◽

Giyoung Lee ◽

Robert Grundmeier ◽

Keith W. Hamilton ◽

...

Keyword(s):

Primary Care ◽

Time Series ◽

Time Series Analysis ◽

Interrupted Time Series ◽

The United States ◽

Pediatric Primary Care ◽

Antibiotic Prescribing ◽

Interrupted Time Series Analysis ◽

Series Analysis ◽

The Impact

BACKGROUND AND OBJECTIVES: With the onset of the coronavirus disease 2019 (COVID-19) pandemic, pediatric ambulatory encounter volume and antibiotic prescribing both decreased; however, the durability of these reductions in pediatric primary care in the United States has not been assessed. METHODS: We conducted a retrospective observational study to assess the impact of the COVID-19 pandemic and associated public health measures on antibiotic prescribing in 27 pediatric primary care practices. Encounters from January 1, 2018, through June 30, 2021, were included. The primary outcome was monthly antibiotic prescriptions per 1000 patients. Interrupted time series analysis was performed. RESULTS: There were 69 327 total antibiotic prescriptions from April through December in 2019 and 18 935 antibiotic prescriptions during the same months in 2020, a 72.7% reduction. The reduction in prescriptions at visits for respiratory tract infection (RTI) accounted for 87.3% of this decrease. Using interrupted time series analysis, overall antibiotic prescriptions decreased from 31.6 to 6.4 prescriptions per 1000 patients in April 2020 (difference of −25.2 prescriptions per 1000 patients; 95% CI: −32.9 to −17.5). This was followed by a nonsignificant monthly increase in antibiotic prescriptions, with prescribing beginning to rebound from April to June 2021. Encounter volume also immediately decreased, and while overall encounter volume quickly started to recover, RTI encounter volume returned more slowly. CONCLUSIONS: Reductions in antibiotic prescribing in pediatric primary care during the COVID-19 pandemic were sustained, only beginning to rise in 2021, primarily driven by reductions in RTI encounters. Reductions in viral RTI transmission likely played a substantial role in reduced RTI visits and antibiotic prescriptions.

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