{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T18:12:09Z","timestamp":1791483129717,"version":"4.3.4"},"reference-count":35,"publisher":"Cambridge University Press (CUP)","issue":"5","license":[{"start":{"date-parts":[[2022,8,15]],"date-time":"2022-08-15T00:00:00Z","timestamp":1660521600000},"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":[[2023,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec id=\"S0899823X22001829_as1\"><jats:title>Objective:<\/jats:title><jats:p>To determine whether a clinician-directed acute respiratory tract infection (ARI) intervention was associated with improved antibiotic prescribing and patient outcomes across a large US healthcare system.<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X22001829_as2\"><jats:title>Design:<\/jats:title><jats:p>Multicenter retrospective quasi-experimental analysis of outpatient visits with a diagnosis of uncomplicated ARI over a 7-year period.<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X22001829_as3\"><jats:title>Participants:<\/jats:title><jats:p>Outpatients with ARI diagnoses: sinusitis, pharyngitis, bronchitis, and unspecified upper respiratory tract infection (URI-NOS). Outpatients with concurrent infection or select comorbid conditions were excluded.<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X22001829_as4\"><jats:title>Intervention(s):<\/jats:title><jats:p>Audit and feedback with peer comparison of antibiotic prescribing rates and academic detailing of clinicians with frequent ARI visits. Antimicrobial stewards and academic detailing personnel delivered the intervention; facility and clinician participation were voluntary.<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X22001829_as5\"><jats:title>Measure(s):<\/jats:title><jats:p>We calculated the probability to receive antibiotics for an ARI before and after implementation. Secondary outcomes included probability for a return clinic visits or infection-related hospitalization, before and after implementation. Intervention effects were assessed with logistic generalized estimating equation models. Facility participation was tracked, and results were stratified by quartile of facility intervention intensity.<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X22001829_as6\"><jats:title>Results:<\/jats:title><jats:p>We reviewed 1,003,509 and 323,023 uncomplicated ARI visits before and after the implementation of the intervention, respectively. The probability to receive antibiotics for ARI decreased after implementation (odds ratio [OR], 0.82; 95% confidence interval [CI], 0.78\u20130.86). Facilities with the highest quartile of intervention intensity demonstrated larger reductions in antibiotic prescribing (OR, 0.69; 95% CI, 0.59\u20130.80) compared to nonparticipating facilities (OR, 0.89; 95% CI, 0.73\u20131.09). Return visits (OR, 1.00; 95% CI, 0.94\u20131.07) and infection-related hospitalizations (OR, 1.21; 95% CI, 0.92\u20131.59) were not different before and after implementation within facilities that performed intensive implementation.<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X22001829_as7\"><jats:title>Conclusions:<\/jats:title><jats:p>Implementation of a nationwide ARI management intervention (ie, audit and feedback with academic detailing) was associated with improved ARI management in an intervention intensity\u2013dependent manner. No impact on ARI-related clinical outcomes was observed.<\/jats:p><\/jats:sec>","DOI":"10.1017\/ice.2022.182","type":"journal-article","created":{"date-parts":[[2022,8,15]],"date-time":"2022-08-15T11:01:55Z","timestamp":1660561315000},"page":"746-754","update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":8,"title":["Implementation and outcomes of a clinician-directed intervention to improve antibiotic prescribing for acute respiratory tract infections within the Veterans\u2019 Affairs Healthcare System"],"prefix":"10.1017","volume":"44","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9933-4120","authenticated-orcid":false,"given":"Karl J.","family":"Madaras-Kelly","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suzette A.","family":"Rovelsky","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2879-3850","authenticated-orcid":false,"given":"Robert A.","family":"McKie","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"McKenna R.","family":"Nevers","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jian","family":"Ying","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin A.","family":"Haaland","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chad L.","family":"Kay","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9985-066X","authenticated-orcid":false,"given":"Melissa L.","family":"Christopher","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lauri A.","family":"Hicks","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mathew H.","family":"Samore","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2022,8,15]]},"reference":[{"key":"S0899823X22001829_ref27","unstructured":"27. National Center for Healthcare Statistics. Veterans\u2019 health statistics. Centers for Diseases Control and Prevention website. https:\/\/www.cdc.gov\/nchs\/nhis\/veterans_health_statistics\/veterans-health-statistics.htm. Accessed November 19, 2021."},{"key":"S0899823X22001829_ref10","doi-asserted-by":"crossref","first-page":"1175","DOI":"10.1016\/S0140-6736(13)60994-0","article-title":"Effects of Internet-based training on antibiotic prescribing rates for acute respiratory-tract infections: a multinational, cluster, randomised, factorial, controlled trial","volume":"382","author":"Little","year":"2013","journal-title":"Lancet"},{"key":"S0899823X22001829_ref25","doi-asserted-by":"publisher","DOI":"10.1093\/ofid\/ofab186"},{"key":"S0899823X22001829_ref16","doi-asserted-by":"crossref","first-page":"513","DOI":"10.1017\/ice.2016.328","article-title":"A report of the efforts of the Veterans\u2019 Health Administration National Antimicrobial Stewardship Initiative","volume":"38","author":"Kelly","year":"2017","journal-title":"Infect Control Hosp Epidemiol"},{"key":"S0899823X22001829_ref8","doi-asserted-by":"crossref","first-page":"425","DOI":"10.1001\/jamainternmed.2013.14191","article-title":"Nudging guideline-concordant antibiotic prescribing: a randomized clinical trial","volume":"174","author":"Meeker","year":"2014","journal-title":"JAMA Intern Med"},{"key":"S0899823X22001829_ref15","doi-asserted-by":"crossref","first-page":"1897","DOI":"10.1001\/archinte.161.15.1897","article-title":"Academic detailing to improve use of broad-spectrum antibiotics at an academic medical center","volume":"161","author":"Solomon","year":"2001","journal-title":"Arch Intern Med"},{"key":"S0899823X22001829_ref20","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/cis370"},{"key":"S0899823X22001829_ref33","doi-asserted-by":"crossref","first-page":"899","DOI":"10.1001\/jama.2021.14131","article-title":"Influenza\u2019s unprecedented low profile during COVID-19 pandemic leaves experts wondering what this flu season has in store","volume":"326","author":"Rubin","year":"2021","journal-title":"JAMA"},{"key":"S0899823X22001829_ref17","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/cix773"},{"key":"S0899823X22001829_ref28","doi-asserted-by":"crossref","unstructured":"28. Yoo, M , Madaras-Kelly, K , Nevers, M , et al. A Veterans\u2019 Healthcare Administration (VHA) antibiotic stewardship intervention to improve outpatient antibiotic use for acute respiratory infections: a cost-effectiveness analysis. Infect Control Hosp Epidemiol 2021. doi: 10.1017\/ice.2021.393.","DOI":"10.1017\/ice.2021.393"},{"key":"S0899823X22001829_ref30","doi-asserted-by":"crossref","first-page":"380","DOI":"10.1111\/bcpt.13040","article-title":"Potentially inappropriate prescribing to older patients: criteria, prevalence and an intervention to reduce it: the prescription peer academic detailing (Rx-PAD) study\u2014a cluster-randomized, educational intervention in Norwegian general practice","volume":"123","author":"Rognstad","year":"2018","journal-title":"Basic Clin Pharmacol Toxicol"},{"key":"S0899823X22001829_ref34","first-page":"e217","article-title":"Unintended consequences of a quality measure for acute bronchitis","volume":"18","author":"Roth","year":"2012","journal-title":"Am J Manag Care"},{"key":"S0899823X22001829_ref35","unstructured":"35. HEDIS measures, antibiotic utilization for respiratory conditions. National Committee on Quality Assurance website. https:\/\/www.ncqa.org\/hedis\/measures\/. 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Corporate Data Warehouse (CDW). US Department of Veterans\u2019 Affairs Health Services Research & Development website. https:\/\/www.hsrd.research.va.gov\/for_researchers\/vinci\/cdw.cfm. 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Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America.","name":"license","label":"License","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}}]}}