BACKGROUND Urgent care (UC; a convenient site to receive care for ambulatory-sensitive) centers conditions; however, UC clinicians showed the highest rate of inappropriate antibiotic prescriptions among outpatient settings according to national billing data. Antibiotic prescribing practices in pediatric-specific UC centers were not known but assumed to require improvement. The aim of this multisite quality improvement project was to reduce inappropriate antibiotic prescribing practices for 3 target diagnoses in pediatric UC centers by a relative 20% by December 1, 2019. METHODS The Society of Pediatric Urgent Care invited pediatric UC clinicians to participate in a multisite quality improvement study from June 2019 to December 2019. The diagnoses included acute otitis media (AOM), otitis media with effusion, and pharyngitis. Algorithms based on published guidelines were used to identify inappropriate antibiotic prescriptions according to indication, agent, and duration. Sites completed multiple intervention cycles from a menu of publicly available antibiotic stewardship materials. Participants submitted data electronically. The outcome measure was the percentage of inappropriate antibiotic prescriptions for the target diagnoses. Process measures were use of delayed antibiotics for AOM and inappropriate testing in pharyngitis. RESULTS From 20 UC centers, 157 providers submitted data from 3833 encounters during the intervention cycles. Overall inappropriate antibiotic prescription rates decreased by a relative 53.9%. Inappropriate antibiotic prescribing decreased from 57.0% to 36.6% for AOM, 54.6% to 48.4% for otitis media with effusion, and 66.9% to 11.7% for pharyngitis. CONCLUSIONS Participating pediatric UC providers decreased inappropriate antibiotic prescriptions from 60.3% to 27.8% using publicly available interventions.

中文翻译：

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多地点合作减少紧急护理中心不适当的抗生素。


背景 紧急护理（UC；为流动敏感患者提供护理的便利场所）中心条件；然而，根据国家账单数据，在门诊环境中，UC 临床医生的抗生素处方不当率最高。儿科特定 UC 中心的抗生素处方实践尚不清楚，但认为需要改进。该多站点质量改进项目的目标是到 2019 年 12 月 1 日，将儿科 UC 中心 3 个目标诊断的不适当抗生素处方做法减少相对 20%。 方法 儿科紧急护理协会邀请儿科 UC 临床医生参加多站点2019年6月至2019年12月的质量改进研究。诊断包括急性中耳炎（AOM）、渗出性中耳炎和咽炎。基于已发布指南的算法用于根据适应症、药物和持续时间识别不适当的抗生素处方。站点根据公开的抗生素管理材料清单完成了多个干预周期。参与者以电子方式提交数据。结果指标是针对目标诊断不适当的抗生素处方的百分比。处理措施包括针对 AOM 使用延迟抗生素以及针对咽炎进行不适当的检测。结果 来自 20 个 UC 中心的 157 名提供者提交了干预周期内 3833 次就诊的数据。总体而言，不适当的抗生素处方率相对下降了 53.9%。 AOM 的不适当抗生素处方从 57.0% 下降到 36.6%，渗出性中耳炎从 54.6% 下降到 48.4%，咽炎从 66.9% 下降到 11.7%。 结论 参与的儿科 UC 提供者使用公开的干预措施将不适当的抗生素处方从 60.3% 减少到 27.8%。