{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,21]],"date-time":"2025-09-21T17:18:12Z","timestamp":1758475092503,"version":"3.40.5"},"reference-count":29,"publisher":"Cambridge University Press (CUP)","issue":"12","license":[{"start":{"date-parts":[[2022,1,31]],"date-time":"2022-01-31T00:00:00Z","timestamp":1643587200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/www.cambridge.org\/core\/terms"}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["Infect. Control Hosp. Epidemiol."],"published-print":{"date-parts":[[2022,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec id=\"S0899823X21005341_as1\"><jats:title>Objective:<\/jats:title><jats:p>To improve appropriate antibiotic prescribing for children in Tennessee.<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X21005341_as2\"><jats:title>Design:<\/jats:title><jats:p>We performed a before-and-after intervention study with 3 comparison periods: period 1 (P1, baseline) May 2018\u2013September 2019; period 2 (P2, intervention before the COVID-19 pandemic) November 11, 2019\u2013March 20, 2020; and period 3 (P3, intervention during the coronavirus disease 2019 [COVID-19] pandemic) March 21, 2020\u2013November 10, 2020. We additionally surveyed participating providers to assess acceptance of the intervention.<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X21005341_as3\"><jats:title>Setting:<\/jats:title><jats:p>Community general pediatrics practices.<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X21005341_as4\"><jats:title>Participants:<\/jats:title><jats:p>In total, 81 general pediatricians, family medicine physicians, and nurse practitioners in 5 general pediatrics practices participated in this study.<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X21005341_as5\"><jats:title>Interventions:<\/jats:title><jats:p>Each practice identified a practice and operations champion for the project. Practices chose 2\u20134 implementation strategies previously shown to be effective at reducing outpatient antibiotic use to implement in their practice throughout the study intervention period. Study personnel also held quarterly meetings with all providers to review deidentified peer comparison feedback both across practices enrolled in the study and at the provider level within each practice.<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X21005341_as6\"><jats:title>Results:<\/jats:title><jats:p>We detected improvements in guideline-concordant antibiotic use in the pre-COVID-19 intervention period, and they were sustained in the study period during the pandemic (P3): otitis media (P1 72.14% vs P2 81.42% vs P3 86.11%), group A streptococcal pharyngitis (P1 66.13% vs P2 81.56% vs P3 80.44%), pneumonia (P1 70.6% vs P2 76.2% vs P3 100%), sinusitis (P1 76.2% vs P2 83.78% vs P3 82.86%), skin and soft-tissue infections (P1 97.18% vs P2 100% vs P3 100%).<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X21005341_as7\"><jats:title>Conclusions:<\/jats:title><jats:p>Bundled implementation strategies led to significant increases in guideline-concordant antibiotic prescribing for all diagnoses. Survey results demonstrate that the bundled implementation strategies were well-accepted by providers.<\/jats:p><\/jats:sec>","DOI":"10.1017\/ice.2021.534","type":"journal-article","created":{"date-parts":[[2022,1,31]],"date-time":"2022-01-31T11:01:13Z","timestamp":1643626873000},"page":"1894-1900","update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":4,"title":["Improvements in appropriate ambulatory antibiotic prescribing using a bundled antibiotic stewardship intervention in general pediatrics practices"],"prefix":"10.1017","volume":"43","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4611-6861","authenticated-orcid":false,"given":"Sophie E.","family":"Katz","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Preston","family":"Spencer","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Janet","family":"Cates","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lora","family":"Harnack","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Meng","family":"Xu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ritu","family":"Banerjee","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"56","published-online":{"date-parts":[[2022,1,31]]},"reference":[{"key":"S0899823X21005341_ref2","first-page":"1308","article-title":"US outpatient antibiotic prescribing variation according to geography, patient population, and provider specialty in 2011","volume":"60","author":"Hicks","journal-title":"Clin Infect Dis"},{"key":"S0899823X21005341_ref3","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2016.4151"},{"key":"S0899823X21005341_ref11","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/cis629"},{"key":"S0899823X21005341_ref14","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciu296"},{"key":"S0899823X21005341_ref13","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2013-1071"},{"key":"S0899823X21005341_ref20","doi-asserted-by":"publisher","DOI":"10.1016\/j.acra.2010.11.017"},{"key":"S0899823X21005341_ref22","doi-asserted-by":"publisher","DOI":"10.1186\/s13012-019-0881-7"},{"key":"S0899823X21005341_ref10","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/cir531"},{"key":"S0899823X21005341_ref1","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.rr6506a1"},{"key":"S0899823X21005341_ref8","doi-asserted-by":"publisher","DOI":"10.1001\/jama.296.10.1235"},{"key":"S0899823X21005341_ref29","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2016.0275"},{"key":"S0899823X21005341_ref21","doi-asserted-by":"publisher","DOI":"10.1186\/s13012-017-0590-z"},{"key":"S0899823X21005341_ref4","doi-asserted-by":"publisher","DOI":"10.1007\/s40121-017-0181-y"},{"key":"S0899823X21005341_ref18","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2021-049972"},{"key":"S0899823X21005341_ref12","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2012-3488"},{"key":"S0899823X21005341_ref9","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2013.14191"},{"key":"S0899823X21005341_ref24","unstructured":"24. Dialogue Around Respiratory Illness Treatment (DART) Interactive Medical Training Resources (IMTR) website. https:\/\/www.uwimtr.org\/dart\/. Accessed December 2, 2021."},{"key":"S0899823X21005341_ref5","doi-asserted-by":"publisher","DOI":"10.1017\/ice.2019.338"},{"key":"S0899823X21005341_ref6","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2020-0038"},{"key":"S0899823X21005341_ref28","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjmed.2012.10.027"},{"key":"S0899823X21005341_ref15","unstructured":"15. US Centers for Medicare & Medicaid Services Quality Improvement Organization Program. MITIGATE antimicrobial stewardship toolkit: a guide for practical implementation in adult and pediatric emergency department and urgent care settings. Centers for Disease Control and Prevention website. https:\/\/stacks.cdc.gov\/view\/cdc\/80653. Published 2018. Accessed December 2, 2021."},{"key":"S0899823X21005341_ref27","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2017-0471"},{"key":"S0899823X21005341_ref7","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2013.6287"},{"key":"S0899823X21005341_ref19","first-page":"e311","article-title":"Electronic health record feedback to improve antibiotic prescribing for acute respiratory infections","volume":"16","author":"Linder","year":"2010","journal-title":"Am J Manag Care"},{"key":"S0899823X21005341_ref17","doi-asserted-by":"publisher","DOI":"10.1093\/jpids\/piaa124"},{"key":"S0899823X21005341_ref16","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciaa1896"},{"key":"S0899823X21005341_ref26","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/cir272"},{"key":"S0899823X21005341_ref23","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2020.15891"},{"key":"S0899823X21005341_ref25","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2007-0819"}],"container-title":["Infection Control &amp; Hospital Epidemiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S0899823X21005341","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,12,14]],"date-time":"2022-12-14T10:25:39Z","timestamp":1671013539000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S0899823X21005341\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,1,31]]},"references-count":29,"journal-issue":{"issue":"12","published-print":{"date-parts":[[2022,12]]}},"alternative-id":["S0899823X21005341"],"URL":"https:\/\/doi.org\/10.1017\/ice.2021.534","relation":{},"ISSN":["0899-823X","1559-6834"],"issn-type":[{"type":"print","value":"0899-823X"},{"type":"electronic","value":"1559-6834"}],"subject":[],"published":{"date-parts":[[2022,1,31]]},"assertion":[{"value":"\u00a9 The Author(s), 2022. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America","name":"copyright","label":"Copyright","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}}]}}