Background Feedback reports summarizing clinician performance are effective tools for improving antibiotic use in the ambulatory setting, but the effectiveness of feedback reports in the hospital setting is unknown. Methods Quasi-experimental study conducted between December 2021 and November 2023 within a pediatric health system measuring the impact of clinician feedback reports delivered by email and reviewed in a monthly meeting on appropriate antibiotic use in children hospitalized with community-acquired pneumonia (CAP). We used an interrupted time series analysis (ITSA) to estimate the immediate change and change over time in the proportion of CAP encounters adherent to validated metrics of antibiotic choice and duration, then used Poisson regression to estimate intervention effect as a rate ratio (RR). Results Preintervention, 213 of 413 (52%) encounters received the appropriate antibiotic choice and duration, which increased to 308 of 387 (80%) postintervention. The ITSA demonstrated an immediate 18% increase in the proportion of CAP encounters receiving both the appropriate antibiotic choice and duration (95% confidence interval, 3-33%), with no further change over time (-0.3% per month, 95% CI -2–2%). In the Poisson model adjusted for age, sex, race, season, site, and intensive care unit admission, the intervention was associated with a 32% increase in the rate of appropriate antibiotic choice and duration (RR 1.32, 95% confidence interval 1.12-1.56, P <0.01). No difference in length of stay or revisits were detected postintervention. Conclusion The intervention was associated with an increase in clinician adherence to antibiotic choice and duration recommendations for children hospitalized with CAP.

中文翻译：

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临床医生反馈报告对社区获得性肺炎住院儿童抗生素使用的影响


背景 总结临床医生表现的反馈报告是改善门诊环境中抗生素使用的有效工具，但反馈报告在医院环境中的有效性尚不清楚。方法 2021 年 12 月至 2023 年 11 月期间在儿科卫生系统内进行的准实验研究，衡量通过电子邮件提供的临床医生反馈报告的影响，并在月度会议上审查社区获得性肺炎 （CAP） 住院儿童适当使用抗生素的影响。我们使用中断时间序列分析 （ITSA） 来估计 CAP 就诊比例的直接变化和随时间的变化，这些比例符合经过验证的抗生素选择和持续时间指标，然后使用泊松回归估计干预效果作为比率 （RR）。结果 干预前，413 例 （52%） 患者中有 213 例 （52%） 接受了适当的抗生素选择和持续时间，干预后 387 例 （80%） 增加到 308 例。ITSA 显示，接受适当抗生素选择和持续时间的 CAP 就诊比例立即增加了 18%（95% 置信区间，3-33%），并且随着时间的推移没有进一步的变化（每月 -0.3%，95% CI -2-2%）。在根据年龄、性别、种族、季节、地点和重症监护病房收治率调整的泊松模型中，干预与适当抗生素选择率和持续时间增加 32% 相关 （RR 1.32,95% 置信区间 1.12-1.56，P <0.01）。干预后未检测到住院时间或复诊时间的差异。结论 干预与临床医生对 CAP 住院儿童抗生素选择和持续时间建议的依从性增加有关。