Pediatric ASP Toolkit

Data and Extraction

• EHR data
• Claims data
• Recurrent reports
• Chart review

Inclusion and Analysis

• Consider data analyst and/or IT support
• Level: facility, clinic, individual
• Frequency: monthly, quarterly
• Benchmarking
• Peer comparison

Available Metrics

• Proportion of total visits resulting in an antibiotic¹
• Proportion of viral acute respiratory tract infections receiving antibiotics²
  • URI HEDIS measure for reimbursement evaluates the number of URIs not receiving an antibiotic³
• Proportion of children diagnosed with Streptococcal pharyngitis receiving an antibiotic other than penicillin or amoxicillin
• Proportion of all respiratory infections visits receiving antibiotics
• Proportion of children with pharyngitis prescribed an antibiotic who did not have a streptococcal test
  • CWP HEDIS measure for reimbursement
• Proportion of acute otitis media, sinusitis, or community-acquired pneumonia receiving broad spectrum antibiotics^4,5
• Duration of therapy⁶
• Adverse drug events
• Incidence of C. difficile infections
• Revisit rate for acute respiratory tract infections
• Appropriateness (tiered classification)^7,8
• Amoxicillin Index⁹
• Azithromycin index (proportion of azithromycin prescribed among all antibiotics prescribed)

Dissemination

• Meetings: institutional, departmental
• Individual provider feedback reports
• Delivery: dashboards, emails

References

1. Poole NM, Shapiro DJ, Fleming-Dutra KE, Hicks LA, Hersh AL, Kronman MP. Antibiotic Prescribing for Children in United States Emergency Departments: 2009-2014. Pediatrics. 2019 Feb;143(2):e20181056. doi: 10.1542/peds.2018-1056. Epub 2019 Jan 8. PMID: 30622156; PMCID: PMC6581044.
2. Ray KN, Shi Z, Gidengil CA, Poon SJ, Uscher-Pines L, Mehrotra A. Antibiotic Prescribing During Pediatric Direct-to-Consumer Telemedicine Visits. Pediatrics. 2019 May;143(5):e20182491. doi: 10.1542/peds.2018-2491. Epub 2019 Apr 8. PMID: 30962253; PMCID: PMC6565339.
3. Yaeger JP, Temte JL, Hanrahan LP, Martinez-Donate P. Roles of Clinician, Patient, and Community Characteristics in the Management of Pediatric Upper Respiratory Tract Infections. Ann Fam Med. 2015 Nov;13(6):529-36. doi: 10.1370/afm.1856. PMID: 26553892; PMCID: PMC4639378.
4. Gerber JS, Ross RK, Bryan M, Localio AR, Szymczak JE, Wasserman R, Barkman D, Odeniyi F, Conaboy K, Bell L, Zaoutis TE, Fiks AG. Association of Broad- vs Narrow-Spectrum Antibiotics With Treatment Failure, Adverse Events, and Quality of Life in Children With Acute Respiratory Tract Infections. JAMA. 2017 Dec 19;318(23):2325-2336. doi: 10.1001/jama.2017.18715. PMID: 29260224; PMCID: PMC5820700.
5. Palms DL, Hicks LA, Bartoces M, Hersh AL, Zetts R, Hyun DY, Fleming-Dutra KE. First-Line Antibiotic Selection in Outpatient Settings. Antimicrob Agents Chemother. 2019 Oct 22;63(11):e01060-19. doi: 10.1128/AAC.01060-19. PMID: 31548186; PMCID: PMC6811424.
6. Frost HM, Becker LF, Knepper BC, Shihadeh KC, Jenkins TC. Antibiotic Prescribing Patterns for Acute Otitis Media for Children 2 Years and Older. J Pediatr. 2020 May;220:109-115.e1. doi: 10.1016/j.jpeds.2020.01.045. Epub 2020 Feb 25. PMID: 32111379; PMCID: PMC7249267.
7. Chua KP, Fischer MA, Linder JA. Appropriateness of outpatient antibiotic prescribing among privately insured US patients: ICD-10-CM based cross sectional study. BMJ. 2019 Jan 16;364:k5092. doi: 10.1136/bmj.k5092. PMID: 30651273; PMCID: PMC6334180.
8. Fleming-Dutra KE, Hersh AL, Shapiro DJ, Bartoces M, Enns EA, File TM Jr, Finkelstein JA, Gerber JS, Hyun DY, Linder JA, Lynfield R, Margolis DJ, May LS, Merenstein D, Metlay JP, Newland JG, Piccirillo JF, Roberts RM, Sanchez GV, Suda KJ, Thomas A, Woo TM, Zetts RM, Hicks LA. Prevalence of Inappropriate Antibiotic Prescriptions Among US Ambulatory Care Visits, 2010-2011. JAMA. 2016 May 3;315(17):1864-73. doi: 10.1001/jama.2016.4151. PMID: 27139059.
9. de Bie S, Kaguelidou F, Verhamme KM, De Ridder M, Picelli G, Straus SM, Giaquinto C, Stricker BH, Bielicki J, Sharland M, Sturkenboom MC; ARPEC study. Using Prescription Patterns in Primary Care to Derive New Quality Indicators for Childhood Community Antibiotic Prescribing. Pediatr Infect Dis J. 2016 Dec;35(12):1317-1323. doi: 10.1097/INF.0000000000001324. PMID: 27626915.