ArticleAntimicrobial stewardship & healthcare epidemiology : ASHE2026
Mixed-method evaluation of interactive provider dashboards for comparison of outpatient antibiotic prescribing for respiratory and otic conditions in walk-in clinics.
Article in Antimicrobial stewardship & healthcare epidemiology : ASHE, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Authors and funding
11 authors.
Funding
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Abstract
Objective: We evaluated how antibiotic use changed after implementation of a multifaceted intervention that sent providers individualized peer-comparison feedback on their antibiotic use for respiratory conditions that do not warrant antibiotics (never-events). Design: An interrupted time-series analysis was performed with a baseline (January 2018-January 2020) and intervention period (November 2021-December 2023), while controlling for COVID-19 era (February 2020-February 2022). Setting: Walk-in ambulatory clinics. Participants: Providers caring for patients in walk-in clinics. Methods: We conducted a mixed-methods study across 7 walk-in clinics in one health system. We included data from visits from 2018-2023 and conducted 17 semi-structured interviews with 10 providers. Results: After intervention implementation, antibiotic use for all visits decreased 8% (RR 0.92, 95% CI 0.86-0.97), then began to increase by 1% per month (RR 1.01, 95% CI 1.00-1.01). Once the intervention started, the use of never-event diagnostic codes decreased by 24% (RR 0.69-0.83) and continued to decrease by 1% per month (RR 0.99, 95% CI 0.98-0.99). Antibiotic use for never-event visits showed no immediate change after the intervention started (RR 0.80, 95% CI 0.61-1.04), then decreased by 3% per month (RR 0.97, 95% CI 0.96-0.98). Some providers valued receiving feedback on the metric; others admitted to shifting their codes. Conclusions: Delivering feedback to walk-in clinic providers was associated with temporary reductions in antibiotic-prescribing across all visits but also changes in diagnostic coding (ie, "gaming"). Antibiotic stewardship programs should monitor for changes in both when implementing new outpatient metrics.
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Registered trials
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