Measurement of Practice-Level Antibiotic Utilization in a Medicaid Patient-Centered Medical Home Program

Area of Science:

• Health Services Research
• Infectious Disease Epidemiology
• Public Health Policy

Background:

• Outpatient antibiotic overuse is a significant public health concern requiring efficient stewardship strategies.
• Patient-Centered Medical Home (PCMH) programs offer a framework for improving primary care delivery and patient outcomes.
• Developing practice-specific utilization measures is crucial for targeted antibiotic stewardship interventions.

Purpose of the Study:

• To develop and implement a claims-based measure for assessing antibiotic utilization within a Medicaid PCMH program.
• To evaluate the feasibility and impact of practice-specific antibiotic prescribing rates on stewardship efforts.
• To compare PCMH antibiotic prescribing data with state and national benchmarks.

Main Methods:

• An observational study analyzed outpatient antibiotic paid claims from PCMH panels between 2019 and 2021.
• Practices received quarterly report cards detailing their antibiotic prescribing rates (paid claims per 1,000 patients per year) compared to peers.
• Prescribing data from Arkansas Medicaid PCMHs were benchmarked against IQVIA all-payer state and national data.

Main Results:

• PCMH antibiotic prescribing rates decreased from 1,089 in 2019 to 853 in 2021.
• These rates were higher than state (1,028 to 927) and national (765 to 636) IQVIA data in 2019, but PCMH rates showed greater reduction by 2021.
• The range of prescribing rates within PCMH practices narrowed significantly from 2019 to 2021, indicating more consistent stewardship.

Conclusions:

• Claims-based measurement of antibiotic prescriptions per 1,000 patients at the practice level is a feasible approach for antibiotic stewardship.
• The implementation of regular feedback through report cards was associated with reduced antibiotic prescribing rates in PCMHs.
• This strategy demonstrates potential for improving antibiotic stewardship in outpatient settings and reducing antimicrobial resistance.