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Off-target Impact of Clinician Feedback Reports on Antibiotic Use in Children With Medical Complexity Hospitalized
Kathleen Chiotos1,2,3,4, Lauren Dutcher5, Robert W Grundmeier3,6
1Division of Critical Care Medicine, Department of Anesthesiology and Critical Care, Children's Hospital of Philadelphia, Philadelphia, PA, United States.
Insights
Clinician audit and feedback reports on antibiotic use improved antibiotic choice and duration in medically complex children, even those not included in the original reports. This suggests broader impacts of such feedback interventions.
Area of Science:
- Pediatrics
- Infectious Diseases
- Health Services Research
Background:
- Previous research showed clinician audit and feedback reports improved antibiotic use in healthy children with community-acquired pneumonia.
- Medically complex children often have different care needs and outcomes related to antibiotic use.
Purpose of the Study:
- To evaluate the off-target impact of clinician audit and feedback reports on antibiotic choice and duration in medically complex children.
- To determine if the intervention's benefits extended beyond the initially studied population.
Main Methods:
- An exploratory study design was used.
- Data were collected on antibiotic choice and duration for medically complex children.
- These children were cared for by clinicians who received audit and feedback reports.
Main Results:
- The feedback report intervention was associated with increased adherence to appropriate antibiotic choice and duration metrics in medically complex children.
- This improvement occurred despite medically complex children being excluded from the original reports.
Conclusions:
- Clinician feedback reports can have a broader impact than the specific population targeted.
- These findings suggest that feedback-based interventions may benefit a wider range of patients.
- Further research is warranted to evaluate the safety and effectiveness of these broader impacts.
Abstract:
In prior work, we demonstrated that clinician audit and feedback reports summarizing adherence to appropriate antibiotic choice and duration metrics in previously healthy children with nonsevere community-acquired pneumonia were associated with improved antibiotic use in this population. In this exploratory study, we evaluated the off-target impact of these reports on antibiotic choice and duration in a small cohort of medically complex children cared for concurrently by these same clinicians. The feedback report-based intervention was also associated with an increase in adherence to the appropriate antibiotic choice and duration metrics among the medically complex children, despite these children being excluded from the reports. These preliminary, hypothesis-generating findings provide proof-of-principle that the impact of clinician feedback reports is broader than the population specifically included in the report, and should inform future studies evaluating the safety and effectiveness of feedback-report-based interventions.
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