Evidence map›Paper›PMID 27242991›Full record

ArticleFrontiers in public health2016

Effect of Financially Punished Audit and Feedback in a Pediatric Setting in China, within an Antimicrobial Stewardship Program, and as Part of an International Accreditation Process.

Sitang Gong, Xiu Qiu, Yanyan Song, Xin Sun, Yanling He, Yilu Chen, Minqing Li, Rui Luo, Liya He, Qing Wei and 10 more

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PubMed Full text at PMC Publisher
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Article in Frontiers in public health, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 16 papers, 4 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
16citing papers in PubMed, 4 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

16 citing papers in PubMed, 4 syntheses or guidelines pooled it.

  1. Pooled it
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

20 authors.

Sitang GongDepartment of Gastroenterology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University , Guangzhou , China.
Xiu QiuDivision of Birth Cohort Study, Guangzhou Women and Children's Medical Center, Guangzhou Medical University , Guangzhou , China.
Yanyan SongDepartment of Medical Administration, Guangzhou Women and Children's Medical Center, Guangzhou Medical University , Guangzhou , China.
Xin SunDepartment of Medical Administration, Guangzhou Women and Children's Medical Center, Guangzhou Medical University , Guangzhou , China.
Yanling HeDepartment of Pharmacy, Guangzhou Women and Children's Medical Center, Guangzhou Medical University , Guangzhou , China.
Yilu ChenDepartment of Pharmacy, Guangzhou Women and Children's Medical Center, Guangzhou Medical University , Guangzhou , China.
Minqing LiDepartment of Medical Administration, Guangzhou Women and Children's Medical Center, Guangzhou Medical University , Guangzhou , China.
Rui LuoDepartment of Medical Administration, Guangzhou Women and Children's Medical Center, Guangzhou Medical University , Guangzhou , China.
Liya HeDepartment of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University , Guangzhou , China.
Qing WeiDepartment of Medical Administration, Guangzhou Women and Children's Medical Center, Guangzhou Medical University , Guangzhou , China.
Songying ShenDivision of Birth Cohort Study, Guangzhou Women and Children's Medical Center, Guangzhou Medical University , Guangzhou , China.
Yu LiuDivision of Birth Cohort Study, Guangzhou Women and Children's Medical Center, Guangzhou Medical University , Guangzhou , China.
Lian ZhangDepartment of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University , Guangzhou , China.
Wei ZhouDepartment of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University , Guangzhou , China.
Ping HuangDepartment of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University , Guangzhou , China.
Jianning MaiDepartment of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University , Guangzhou , China.
Li LiuDepartment of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University , Guangzhou , China.
Yi XuDepartment of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University , Guangzhou , China.
Huiying LiangGuangzhou Women and Children's Medical Center, Institute of Pediatrics, Guangzhou Medical University , Guangzhou , China.
Huimin XiaDepartment of Pediatric Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University , Guangzhou , China.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundPrior authorization, audit and feedback, and pay for performance are the three core "active" strategies of antimicrobial stewardship program (ASP), yet little is known about the individual or combined benefits of such programs, particularly in a pediatric setting.

objectivesThe aim of this study was to compare these core ASP strategies and determine the incremental effect of financially punished audit and feedback.

methodsDuring the journey to the Joint Commission International accreditation, a tertiary pediatric medical center performed two different hospital-wide stewardship interventions in succession. The first stage without formalized ASPs served as pre-intervention period, January 2011 to April 2011. The ASP used prior authorization alone during the first-intervention period, May 2011 to September 2011. In October 2011, financially punished audit and feedback was introduced, marking the start of the second-intervention period, October 2011 to November 2012. We compared the differences of the change in monthly average use of antibiotics and expenditure on antibiotics before and after the ASP changes by using interrupted time series via dynamic regression. The main end points included the proportions of antibiotic prescriptions and expenditure on antibacterial relative to all medications.

resultsBefore the second-intervention period, neither the proportion of antibiotic prescriptions nor the proportion of expenditure on antibiotics declined significantly in both ambulatory and inpatient settings. However, after the introduction of financially punished audit and feedback, the proportion of both antibiotic prescriptions (β = -6.269, P < 0.001, and reduction = 59.4% for outpatients; β = -1.235, P < 0.001, and reduction = 19.8% for inpatients) and expenditure on antibiotics (β = -7.777, P < 0.001, and reduction = 46.7% for outpatients; β = -4.933, P = 0.001, and reduction = 16.3% for inpatients) dropped immediately.

conclusionThe combination of more than one core strategies (prior authorization, audit and feedback, and pay for performance) will be more effective than one strategy alone.

Indexed as

antimicrobial prescriptionantimicrobial stewardshipaudit and feedbackobservational studypay for performanceprior authorization

Identifiers

PMID27242991
PMCPMC4870519

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.