Improving Guideline-Based Streptococcal Pharyngitis Testing: A Quality Improvement Initiative

Area of Science:

• Pediatric Infectious Diseases
• Quality Improvement Science
• Clinical Practice Guidelines

Background:

• Acute pharyngitis is a frequent pediatric diagnosis.
• Infectious Diseases Society of America (IDSA) guidelines recommend specific criteria for group A Streptococcus (GAS) testing to prevent misdiagnosis and overtreatment.
• Adherence to these GAS testing guidelines in ambulatory pediatrics is often suboptimal.

Purpose of the Study:

• To enhance adherence to the IDSA clinical practice guideline for GAS pharyngitis testing and treatment.
• To reduce unnecessary GAS testing in a large community pediatric practice.
• To improve the appropriate diagnosis and management of acute pharyngitis in children.

Main Methods:

• A quality improvement project utilizing the Model for Improvement and Plan-Do-Study-Act cycles.
• Interventions included provider education, procedural modifications, enhanced communication strategies, and patient/family education.
• Outcomes were evaluated using statistical process control charts and assessed for American Board of Pediatrics Part 4 Maintenance of Certification credit.

Main Results:

• Unnecessary GAS testing decreased by an absolute 23.5% (from 64% to 40.5%).
• Viral symptoms were identified as the main driver for inappropriate testing.
• Appropriate antibiotic use remained stable, while inappropriate use decreased due to reduced unnecessary testing. Provider confidence in communicating testing and treatment rationale improved.

Conclusions:

• Pre-intervention GAS pharyngitis testing practices were largely inconsistent with IDSA guideline recommendations.
• The implemented quality improvement initiative successfully improved adherence to guideline-based GAS pharyngitis testing.
• The project achieved its goal of optimizing GAS testing and treatment in a pediatric setting.