Impact of a national guideline on antibiotic selection for hospitalized pneumonia

Pediatric Research in Inpatient Settings Network

Research output: Contribution to journalArticle

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Abstract

BACKGROUND: We evaluated the impact of the 2011 Pediatric Infectious Diseases Society/Infectious Diseases Society of America pneumonia guideline and hospital-level implementation efforts on antibiotic prescribing for children hospitalized with pneumonia. METHODS: We assessed inpatient antibiotic prescribing for pneumonia at 28 children's hospitals between August 2009 and March 2015. Each hospital was also surveyed regarding local implementation efforts targeting antibiotic prescribing and organizational readiness to adopt guideline recommendations. To estimate guideline impact, we used segmented linear regression to compare the proportion of children receiving penicillins in March 2015 with the expected proportion at this same time point had the guideline not been published based on a projection of a preguideline trend. A similar approach was used to estimate the short-term (6-month) impact of local implementation efforts. The correlations between organizational readiness and the impact of the guideline were estimated by using Pearson's correlation coefficient. RESULTS: Before guideline publication, penicillin prescribing was rare (<10%). After publication, an absolute increase in penicillin use was observed (27.6% [95% confidence interval: 23.7%-31.5%]) by March 2015. Among hospitals with local implementation efforts (n=20, 71%), the median increase was 29.5% (interquartile range: 19.6%-39.1%) compared with 20.1% (interquartile rage: 9.5%-44.5%) among hospitals without such activities (P=.51). The independent, short-term impact of local implementation efforts was similar in magnitude to that of the national guideline.organizational readiness was not correlated with prescribing changes. CONCLUSIONS: The publication of the Pediatric Infectious Diseases Society/Infectious Diseases Society of America guideline was associated with sustained increases in the use of penicillins for children hospitalized with pneumonia. Local implementation efforts may have enhanced guideline adoption and appeared more relevant than hospitals' organizational readiness to change.

Original languageEnglish (US)
Article numbere20163231
JournalPediatrics
Volume139
Issue number4
DOIs
StatePublished - Apr 1 2017

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Pneumonia
Guidelines
Anti-Bacterial Agents
Penicillins
Publications
Hospitalized Child
Communicable Diseases
Rage
Pediatrics
Inpatients
Linear Models
Confidence Intervals

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

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Impact of a national guideline on antibiotic selection for hospitalized pneumonia. / Pediatric Research in Inpatient Settings Network.

In: Pediatrics, Vol. 139, No. 4, e20163231, 01.04.2017.

Research output: Contribution to journalArticle

Pediatric Research in Inpatient Settings Network 2017, 'Impact of a national guideline on antibiotic selection for hospitalized pneumonia', Pediatrics, vol. 139, no. 4, e20163231. https://doi.org/10.1542/peds.2016-3231
Pediatric Research in Inpatient Settings Network. / Impact of a national guideline on antibiotic selection for hospitalized pneumonia. In: Pediatrics. 2017 ; Vol. 139, No. 4.
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title = "Impact of a national guideline on antibiotic selection for hospitalized pneumonia",
abstract = "BACKGROUND: We evaluated the impact of the 2011 Pediatric Infectious Diseases Society/Infectious Diseases Society of America pneumonia guideline and hospital-level implementation efforts on antibiotic prescribing for children hospitalized with pneumonia. METHODS: We assessed inpatient antibiotic prescribing for pneumonia at 28 children's hospitals between August 2009 and March 2015. Each hospital was also surveyed regarding local implementation efforts targeting antibiotic prescribing and organizational readiness to adopt guideline recommendations. To estimate guideline impact, we used segmented linear regression to compare the proportion of children receiving penicillins in March 2015 with the expected proportion at this same time point had the guideline not been published based on a projection of a preguideline trend. A similar approach was used to estimate the short-term (6-month) impact of local implementation efforts. The correlations between organizational readiness and the impact of the guideline were estimated by using Pearson's correlation coefficient. RESULTS: Before guideline publication, penicillin prescribing was rare (<10{\%}). After publication, an absolute increase in penicillin use was observed (27.6{\%} [95{\%} confidence interval: 23.7{\%}-31.5{\%}]) by March 2015. Among hospitals with local implementation efforts (n=20, 71{\%}), the median increase was 29.5{\%} (interquartile range: 19.6{\%}-39.1{\%}) compared with 20.1{\%} (interquartile rage: 9.5{\%}-44.5{\%}) among hospitals without such activities (P=.51). The independent, short-term impact of local implementation efforts was similar in magnitude to that of the national guideline.organizational readiness was not correlated with prescribing changes. CONCLUSIONS: The publication of the Pediatric Infectious Diseases Society/Infectious Diseases Society of America guideline was associated with sustained increases in the use of penicillins for children hospitalized with pneumonia. Local implementation efforts may have enhanced guideline adoption and appeared more relevant than hospitals' organizational readiness to change.",
author = "{Pediatric Research in Inpatient Settings Network} and Williams, {Derek J.} and Matthew Hall and Gerber, {Jeffrey S.} and Neuman, {Mark I.} and Hersh, {Adam L.} and Brogan, {Thomas V.} and Kavita Parikh and Sanjay Mahant and Blaschke, {Anne J.} and Shah, {Samir S.} and Grijalva, {Carlos G.} and Rey Gomez and Susan Wu and Srinivas, {Nivedita S.} and Arana, {Julia G.} and McCann, {Teresa A.} and Jen Weyandt and Chris Miller and Arnold, {Sandra R.} and Hofto, {Meghan E.} and Hines, {Andrea Green} and Martin, {Judith M.} and Jim O'Callaghan and Gunkelman, {Samantha M.} and Suchitra Rao and Clarke, {Daxa P.} and Johnson, {Matthew B.} and Jared Beavers and Rebecca Wallihan and Wallace, {Sowdhamini S.} and Castagnini, {Luis A.} and Woo, {Susan S.} and Mendoza, {Joanne C.} and Pierce, {Heather C.} and Gian Musarra and Flett, {Kelly B.} and Sonal Kalburgi and Elaine Cox and Clifford Chen and Osburn, {T. Shea} and Ean Miller",
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AU - Pediatric Research in Inpatient Settings Network

AU - Williams, Derek J.

AU - Hall, Matthew

AU - Gerber, Jeffrey S.

AU - Neuman, Mark I.

AU - Hersh, Adam L.

AU - Brogan, Thomas V.

AU - Parikh, Kavita

AU - Mahant, Sanjay

AU - Blaschke, Anne J.

AU - Shah, Samir S.

AU - Grijalva, Carlos G.

AU - Gomez, Rey

AU - Wu, Susan

AU - Srinivas, Nivedita S.

AU - Arana, Julia G.

AU - McCann, Teresa A.

AU - Weyandt, Jen

AU - Miller, Chris

AU - Arnold, Sandra R.

AU - Hofto, Meghan E.

AU - Hines, Andrea Green

AU - Martin, Judith M.

AU - O'Callaghan, Jim

AU - Gunkelman, Samantha M.

AU - Rao, Suchitra

AU - Clarke, Daxa P.

AU - Johnson, Matthew B.

AU - Beavers, Jared

AU - Wallihan, Rebecca

AU - Wallace, Sowdhamini S.

AU - Castagnini, Luis A.

AU - Woo, Susan S.

AU - Mendoza, Joanne C.

AU - Pierce, Heather C.

AU - Musarra, Gian

AU - Flett, Kelly B.

AU - Kalburgi, Sonal

AU - Cox, Elaine

AU - Chen, Clifford

AU - Osburn, T. Shea

AU - Miller, Ean

PY - 2017/4/1

Y1 - 2017/4/1

N2 - BACKGROUND: We evaluated the impact of the 2011 Pediatric Infectious Diseases Society/Infectious Diseases Society of America pneumonia guideline and hospital-level implementation efforts on antibiotic prescribing for children hospitalized with pneumonia. METHODS: We assessed inpatient antibiotic prescribing for pneumonia at 28 children's hospitals between August 2009 and March 2015. Each hospital was also surveyed regarding local implementation efforts targeting antibiotic prescribing and organizational readiness to adopt guideline recommendations. To estimate guideline impact, we used segmented linear regression to compare the proportion of children receiving penicillins in March 2015 with the expected proportion at this same time point had the guideline not been published based on a projection of a preguideline trend. A similar approach was used to estimate the short-term (6-month) impact of local implementation efforts. The correlations between organizational readiness and the impact of the guideline were estimated by using Pearson's correlation coefficient. RESULTS: Before guideline publication, penicillin prescribing was rare (<10%). After publication, an absolute increase in penicillin use was observed (27.6% [95% confidence interval: 23.7%-31.5%]) by March 2015. Among hospitals with local implementation efforts (n=20, 71%), the median increase was 29.5% (interquartile range: 19.6%-39.1%) compared with 20.1% (interquartile rage: 9.5%-44.5%) among hospitals without such activities (P=.51). The independent, short-term impact of local implementation efforts was similar in magnitude to that of the national guideline.organizational readiness was not correlated with prescribing changes. CONCLUSIONS: The publication of the Pediatric Infectious Diseases Society/Infectious Diseases Society of America guideline was associated with sustained increases in the use of penicillins for children hospitalized with pneumonia. Local implementation efforts may have enhanced guideline adoption and appeared more relevant than hospitals' organizational readiness to change.

AB - BACKGROUND: We evaluated the impact of the 2011 Pediatric Infectious Diseases Society/Infectious Diseases Society of America pneumonia guideline and hospital-level implementation efforts on antibiotic prescribing for children hospitalized with pneumonia. METHODS: We assessed inpatient antibiotic prescribing for pneumonia at 28 children's hospitals between August 2009 and March 2015. Each hospital was also surveyed regarding local implementation efforts targeting antibiotic prescribing and organizational readiness to adopt guideline recommendations. To estimate guideline impact, we used segmented linear regression to compare the proportion of children receiving penicillins in March 2015 with the expected proportion at this same time point had the guideline not been published based on a projection of a preguideline trend. A similar approach was used to estimate the short-term (6-month) impact of local implementation efforts. The correlations between organizational readiness and the impact of the guideline were estimated by using Pearson's correlation coefficient. RESULTS: Before guideline publication, penicillin prescribing was rare (<10%). After publication, an absolute increase in penicillin use was observed (27.6% [95% confidence interval: 23.7%-31.5%]) by March 2015. Among hospitals with local implementation efforts (n=20, 71%), the median increase was 29.5% (interquartile range: 19.6%-39.1%) compared with 20.1% (interquartile rage: 9.5%-44.5%) among hospitals without such activities (P=.51). The independent, short-term impact of local implementation efforts was similar in magnitude to that of the national guideline.organizational readiness was not correlated with prescribing changes. CONCLUSIONS: The publication of the Pediatric Infectious Diseases Society/Infectious Diseases Society of America guideline was associated with sustained increases in the use of penicillins for children hospitalized with pneumonia. Local implementation efforts may have enhanced guideline adoption and appeared more relevant than hospitals' organizational readiness to change.

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