Improving Short Course Treatment of Pediatric Infections: A Randomized Quality Improvement Trial

Area of Science:

• Pediatric primary care
• Quality improvement initiatives
• Infectious disease management

Background:

• Short antibiotic courses are effective for pediatric community-acquired pneumonia (CAP) and skin and soft tissue infections (SSTI).
• Optimizing antibiotic duration is crucial for effective treatment and antimicrobial stewardship.
• Primary care clinicians' prescribing habits influence treatment outcomes.

Purpose of the Study:

• To compare the effectiveness of education with performance feedback, clinical decision support (CDS), and a combined approach in promoting appropriate short antibiotic treatment durations for pediatric CAP and SSTI.
• To evaluate the impact of different quality improvement strategies on clinician behavior.

Main Methods:

• A site-randomized quality improvement trial was conducted in a pediatric primary care network.
• Practices were assigned to four groups: education/feedback, CDS, combined intervention, or control.
• Difference-in-differences analysis compared short-course treatment proportions before and after interventions.

Main Results:

• The proportion of recommended short-course treatments increased significantly in all intervention groups compared to the control group (P < .001).
• Education/feedback group: 22.3% to 45.0%. CDS group: 26.6% to 52.3%. Combined group: 26.2% to 67.8%.
• The combined intervention group showed substantially greater improvement than either individual strategy (P < .001).

Conclusions:

• Both education with performance feedback and CDS effectively modified clinician prescribing behavior for pediatric CAP and SSTI.
• The combination of education/feedback and CDS was substantially more effective than either intervention alone in promoting shorter antibiotic durations.
• Quality improvement strategies can successfully encourage appropriate antibiotic prescribing in primary care settings.