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Increasing Short-Course Treatment of Acute Otitis Media in a Pediatric Primary Care Network
Naveed Rabbani1,2,3, Laura Burckett Patane1, Jonathan Hatoun1,2,3,4
1Pediatric Physicians' Organization at Children's, Wellesley, Massachusetts.
Insights
Shorter antibiotic prescriptions for acute otitis media (AOM) increased to 60% in children aged 2+ years. This was achieved through clinician education, feedback, and EHR preference lists, avoiding EHR alerts.
Area of Science:
- Pediatric Primary Care
- Quality Improvement
- Infectious Disease Management
Background:
- Acute otitis media (AOM) is a common pediatric infection.
- Shorter antibiotic durations are recommended for AOM to reduce resistance.
- Current prescribing practices often favor longer durations.
Purpose of the Study:
- To increase the proportion of shorter-duration antibiotic prescriptions for AOM in children aged 2 years and older.
- To achieve a target of 50% shorter-duration prescriptions from a baseline of 30%.
- To implement interventions without relying on electronic health record (EHR) alerts.
Main Methods:
- A quality improvement project using two plan-do-study-act cycles in a pediatric primary care network.
- Cycle 1: Updated electronic prescription orders with "speed button" options for shorter durations.
- Cycle 2: Combined education, clinician-specific feedback, and EHR "preference lists" for shorter antibiotic durations.
Main Results:
- The initial intervention (speed buttons) was ineffective.
- The combined intervention (education, feedback, preference lists) increased shorter-duration AOM prescriptions to approximately 60%.
- A small, statistically significant increase in a balancing measure (longer prescriptions for younger children) was observed (+1.8%).
Conclusions:
- Education combined with clinician feedback and EHR preference lists effectively increased shorter-duration AOM prescriptions.
- This approach successfully improved prescribing habits without utilizing EHR alerts.
- The findings support the use of integrated clinical decision support tools for optimizing antibiotic stewardship.
Objective:
This quality improvement effort aimed to increase the proportion of shorter-duration prescriptions for acute otitis media (AOM) in patients aged at least 2 years from a baseline of 30% to 50% without using an electronic health record (EHR) alert.
Methods:
The project was conducted in a large pediatric primary care network and used 2 plan-do-study-act cycles. Cycle 1 included updates to the electronic prescription orders of commonly used antibiotics to include shorter-duration "speed button" options. Cycle 2 combined education with clinician-specific performance feedback and clinical decision support in the form of a "preference list" of easily searchable, preconfigured electronic prescription orders with shorter durations. Weekly proportions of prescriptions for AOM with a duration of 7 days or fewer in children aged at least 2 years (primary measure) and a duration of fewer than 10 days in children aged less than 2 years (balancing measure) were analyzed. Interrupted time series models tested the association of interventions with observed changes in primary and balancing measures.
Results:
The first intervention was ineffective at improving the primary measure. A combination of education, targeted feedback, and preconfigured prescription orders increased shorter-duration treatment courses for AOM by a factor of 2-fold to approximately 60% with an undesired small but statistically significant increase in the balancing measure (+1.8%).
Conclusion:
A combination of education with feedback and in-line clinical decision support in the form of easily searchable, preconfigured prescription orders (EHR "preference list") was successful in increasing shorter-duration prescriptions for AOM in a large primary care network without an EHR alert.
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