Improving Short Course Treatment of Pediatric Infections: A Randomized Quality Improvement Trial.
Document Type
Article
Publication Date
1-1-2024
Identifier
DOI: 10.1542/peds.2023-063691
Abstract
BACKGROUND AND OBJECTIVES: Short courses of antibiotic treatment are effective for pediatric community-acquired pneumonia (CAP) and skin and soft tissue infections (SSTI). We compared the effectiveness of education with performance feedback, clinical decision support (CDS), and the combination in encouraging appropriately short treatment courses by primary care clinicians.
METHODS: We designed a site-randomized, quality improvement trial within a large pediatric primary care network. Each practice was randomly assigned to 1 of 4 groups: education and feedback; CDS; both interventions ("combined group"); and control. We performed difference-in-differences analysis to compare the proportion of cases with short course treatment before and after intervention among the 4 groups.
RESULTS: For all cases of CAP and SSTI, the proportion in the control group treated with the recommended duration did not change from the baseline period (26.1% [679 of 2603]) to the intervention period (25.8% [196 of 761]; P = .9). For the education and feedback group, the proportion rose from 22.3% (428 of 1925) to 45.0% (239 of 532; P < .001); for the CDS group, from 26.6% (485 of 1824) to 52.3% (228 of 436; P < .001); and for the combined group, from 26.2% (491 of 1875) to 67.8% (314 of 463; P < .001). A difference-in-differences analysis showed that all 3 intervention groups improved performance compared with the control group (P < .001); the combined group had greater improvement than the education and feedback group or the CDS group (P < .001).
CONCLUSIONS: In this quality improvement project to encourage shorter duration treatment of CAP and SSTI, both education with performance feedback and CDS were effective in modifying clinician behavior; however, the combination of the two was substantially more effective than either strategy alone.
Journal Title
Pediatrics
Volume
153
Issue
2
MeSH Keywords
Humans; Child; Quality Improvement; Anti-Bacterial Agents; Pneumonia; Cluster Analysis; Community-Acquired Infections
Keywords
Quality Improvement; Anti-Bacterial Agents; Pneumonia; Cluster Analysis; Community-Acquired Infections
Recommended Citation
Vernacchio L, Hatoun J, Patane LB, O'Donnell H, Herigon JC. Improving Short Course Treatment of Pediatric Infections: A Randomized Quality Improvement Trial. Pediatrics. 2024;153(2):e2023063691. doi:10.1542/peds.2023-063691
COinS
