91 - development of an Electronic Algorithm to Identify Inappropriate Antibiotic Prescribing for Pediatric Otitis Media

Background: Antibiotic stewardship (AS) interventions have primarily focused on acute care settings. The majority of antibiotic use, however, occurs in outpatients. The electronic health record (EHR) might provide an effective and efficient tool for outpatient AS. We aimed to develop and validate an electronic algorithm to identify inappropriate antibiotic use for pediatric outpatients with acute otitis media (AOM).

Methods: Within the Children’s Hospital of Philadelphia (CHOP) Care Network, we used ICD-10 diagnostic codes to identify patient encounters for AOM at any CHOP practice between 3/15/17 – 3/14/18. Exclusion criteria included underlying immunocompromising condition, comorbidities, and concurrent infections that might influence antibiotic use. We randomly selected 450 eligible subjects (150 each from academic practices, non-academic practices, and urgent care). Inappropriate antibiotic use based on CHOP and professional society guidelines were assessed via chart review and served as the basis for assessment of the electronic algorithm which was constructed using only data in the electronic health record (EHR). Criteria for appropriateness focused on the decision to prescribe, the choice of antibiotic, and duration of therapy.

Results: Of 450 subjects, median age was 2, 46% were female, and 88% were evaluated by a physician (vs. advanced practice provider). On chart review, the prescribing decision was correct in 438 (97%), of which 25 appropriately received no antibiotics. Of the 413 subjects who were appropriately prescribed an antibiotic, the choice of antibiotic was appropriate in 37 (9%). Finally, of the 413 patients who were appropriately treated, 412 (99.7%) received the correct duration. Test characteristics of the EHR algorithm (compared to chart review) are noted in the Table.

Conclusion: For children with AOM, an electronic algorithm for identification of inappropriate antibiotic prescribing is highly accurate. This algorithm can also highlight for which elements of prescribing the impact of an intervention might be greatest (i.e., choice of agent).  Future work should validate this approach in other health systems and geographic regions and evaluate the impact of an audit and feedback intervention based on this tool.Table. Test Characteristics of Electronic Algorithm for Inappropriate Prescribing, Agent, and Duration

Co-Author(s)

• 

  Ebbing Lautenbach, MD, MPH, MSCE

  Professor of Medicine and Epidemiology
  University of Pennsylvania
  Philadelphia, Pennsylvania

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Presenting Author(s)

• 

  Jeffrey Gerber, MD, PhD

  Associate Professor of Pediatrics
  Children's Hospital of Philadelphia
  Philadelphia, PA

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

  Slides

Co-Author(s)

• RG

  Robert Grundmeier, MD

  Associate Professor
  Children's Hospital of Philadelphia
  Philadelphia, Pennsylvania

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• KH

  Keith W. Hamilton, MD

  Associate Professor Of Clinical Medicine
  Hospital of the University of Pennsylvania
  Philadelphia, PA

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• 

  Lauri Hicks, DO

  Director, Office of Antibiotic Stewardship
  Centers for Disease Control and Prevention
  Atlanta, Georgia

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• MN

  Melinda M. Neuhauser, PharmD, MPH

  Pharmacist and Acute Care Lead
  Centers for Disease Control and Prevention
  Chicago, Illinois

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• NF

  Nicole Frager, MPH

  Project Manager
  University of Pennsylvania
  Philadelphia, Pennsylvania

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• MM

  Muida Menon, MS

  Research Coordinator
  Children's Hospital of Philadelphia
  Philadelphia, Pennsylvania

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• EK

  Ellen Kratz, BA

  Project Manager
  Children's Hospital of Philadelphia
  Philadelphia, Pennsylvania

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• AJ

  Anne Jaskowiak, MS

  Project Manager
  University of Pennsylvania
  Philadelphia, Pennsylvania

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• LC

  Leigh Cressman, MA

  Biostatistician
  University of Pennsylvania School of Medicine
  Philadelphia, Pennsylvania

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• TJ

  Tony James, BA

  Research Assistant
  University of Pennsylvania
  Philadelphia, Pennsylvania

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• JO

  Jacqueline Omorogbe, MBE

  Research Coordinator
  University of Pennsylvania
  Philadelphia, Pennsylvania

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.