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

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This quality improvement project reduced unnecessary group A Streptococcus (GAS) testing for acute pharyngitis in children by 23.5%. Adherence to clinical guidelines for GAS pharyngitis diagnosis and treatment improved significantly.

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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.