{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T13:32:50Z","timestamp":1783949570678,"version":"3.55.0"},"reference-count":28,"publisher":"Cambridge University Press (CUP)","issue":"S3","license":[{"start":{"date-parts":[[2016,5,10]],"date-time":"2016-05-10T00:00:00Z","timestamp":1462838400000},"content-version":"unspecified","delay-in-days":587,"URL":"https:\/\/www.cambridge.org\/core\/terms"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Infect. Control Hosp. Epidemiol."],"published-print":{"date-parts":[[2014,10]]},"abstract":"<jats:sec id=\"S0899823X00194036_abs1\"><jats:title>Objective.<\/jats:title><jats:p>To compare practice patterns regarding the diagnosis and management of streptococcal pharyngitis across pediatric primary care practices.<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X00194036_abs2\"><jats:title>Design.<\/jats:title><jats:p>Retrospective cohort study.<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X00194036_abs3\"><jats:title>Setting.<\/jats:title><jats:p>All encounters to 25 pediatric primary care practices sharing an electronic health record.<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X00194036_abs4\"><jats:title>Methods.<\/jats:title><jats:p>Streptococcal pharyngitis was defined by an<jats:italic>International Classification of Diseases, Ninth Revision<\/jats:italic>code for acute pharyngitis, positive laboratory test, antibiotic prescription, and absence of an alternative bacterial infection. Logistic regression models standardizing for patient-level characteristics were used to compare diagnosis, testing, and broad-spectrum antibiotic treatment for children with pharyngitis across practices. Fixed-effects models and likelihood ratio tests were conducted to analyze within-practice variation.<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X00194036_abs5\"><jats:title>Results.<\/jats:title><jats:p>Of 399,793 acute encounters in 1 calendar year, there were 52,658 diagnoses of acute pharyngitis, including 12,445 diagnoses of streptococcal pharyngitis. After excluding encounters by patients with chronic conditions and standardizing for age, sex, insurance type, and race, there was significant variability across and within practices in the diagnosis and testing for streptococcal pharyngitis. Excluding patients with antibiotic allergies or prior antibiotic use, off-guideline antibiotic prescribing for confirmed group A streptococcal pharyngitis ranged from 1% to 33% across practices (<jats:italic>P<\/jats:italic>&lt; .001). At the clinician level, 13 of 25 sites demonstrated significant within-practice variability in off-guideline antibiotic prescribing (<jats:italic>P<\/jats:italic>\u2264 .05). Only 18 of the 222 clinicians in the network accounted for half of all off-guideline antibiotic prescribing.<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X00194036_abs6\"><jats:title>Conclusions.<\/jats:title><jats:p>Significant variability in the diagnosis and treatment of pharyngitis exists across and within pediatric practices, which cannot be explained by relevant clinical or demographic factors. Our data support clinician-targeted interventions to improve adherence to prescribing guidelines for this common condition.<\/jats:p><\/jats:sec>","DOI":"10.1017\/s0899823x00194036","type":"journal-article","created":{"date-parts":[[2016,8,3]],"date-time":"2016-08-03T06:49:43Z","timestamp":1470206983000},"page":"S79-S85","source":"Crossref","is-referenced-by-count":15,"title":["Variability in the Diagnosis and Treatment of Group A Streptococcal Pharyngitis by Primary Care Pediatricians"],"prefix":"10.1017","volume":"35","author":[{"given":"Julie L.","family":"Fierro","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Priya A.","family":"Prasad","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A. Russell","family":"Localio","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert W.","family":"Grundmeier","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard C.","family":"Wasserman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Theoklis E.","family":"Zaoutis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey S.","family":"Gerber","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2016,5,10]]},"reference":[{"key":"S0899823X00194036_ref008","doi-asserted-by":"publisher","DOI":"10.1001\/jama.291.13.1587"},{"key":"S0899823X00194036_ref013","doi-asserted-by":"publisher","DOI":"10.1001\/jama.287.23.3096"},{"key":"S0899823X00194036_ref005","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM200101183440308"},{"key":"S0899823X00194036_ref015","doi-asserted-by":"publisher","DOI":"10.1001\/jama.294.18.2315"},{"key":"S0899823X00194036_ref026","unstructured":"Appropriate testing for children with pharyngitis: percentage of children 2 to 18 years of age who were diagnosed with pharyngitis, dispensed an antibiotic, and received a group A streptococcus (strep) test for the episode. Rockville, MD: National Quality Measures Clearinghouse, Agency for Healthcare Research and Quality. http:\/\/www.qualitymeasures.ahrq.gov\/content.aspx?id=47165. Accessed August 22, 2014."},{"key":"S0899823X00194036_ref017","doi-asserted-by":"publisher","DOI":"10.1086\/524891"},{"key":"S0899823X00194036_ref011","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/cis847"},{"key":"S0899823X00194036_ref002","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa013169"},{"key":"S0899823X00194036_ref012","first-page":"1153","volume":"60","year":"2011","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"S0899823X00194036_ref004","volume-title":"Closing the Quality Gap: A Critical Analysis of Quality Improvement Strategies","volume":"4","author":"Ranji","year":"2006"},{"key":"S0899823X00194036_ref024","doi-asserted-by":"publisher","DOI":"10.1007\/BF02596317"},{"key":"S0899823X00194036_ref028","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2011-1198"},{"key":"S0899823X00194036_ref016","volume-title":"Antimicrobial Resistance: Issues and Options; Workshop Report","author":"Harrison","year":"1998"},{"key":"S0899823X00194036_ref019","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1542\/peds.106.S1.205","article-title":"Pediatric deaths attributable to complex chronic conditions: a population-based study of Washington State, 1980-1997","volume":"106","author":"Feudtner","year":"2000","journal-title":"Pediatrics"},{"key":"S0899823X00194036_ref010","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-134-6-200103200-00018"},{"key":"S0899823X00194036_ref027","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2013-3260"},{"key":"S0899823X00194036_ref001","doi-asserted-by":"publisher","DOI":"10.1086\/499406"},{"key":"S0899823X00194036_ref022","first-page":"811","article-title":"The validity of a sore throat score in family practice","volume":"163","author":"McIsaac","year":"2000","journal-title":"CMAJ"},{"key":"S0899823X00194036_ref025","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2011-1337"},{"key":"S0899823X00194036_ref021","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.1975.00330110083011"},{"key":"S0899823X00194036_ref009","volume-title":"Group A Streptococcal Infections","year":"2012"},{"key":"S0899823X00194036_ref006","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1995.03520270048030"},{"key":"S0899823X00194036_ref020","volume-title":"Antibiotic Resistance Threats in the United States, 2013","year":"2013"},{"key":"S0899823X00194036_ref007","doi-asserted-by":"crossref","first-page":"949","DOI":"10.1542\/peds.97.6.949","article-title":"Acute pharyngitis: etiology and diagnosis","volume":"97","author":"Bisno","year":"1996","journal-title":"Pediatrics"},{"key":"S0899823X00194036_ref018","doi-asserted-by":"publisher","DOI":"10.1542\/peds.104.6.1251"},{"key":"S0899823X00194036_ref023","doi-asserted-by":"publisher","DOI":"10.1177\/0272989X8100100304"},{"key":"S0899823X00194036_ref014","doi-asserted-by":"publisher","DOI":"10.1086\/322627"},{"key":"S0899823X00194036_ref003","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1996.03530280052036"}],"container-title":["Infection Control &amp; Hospital Epidemiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S0899823X00194036","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,7,4]],"date-time":"2022-07-04T20:38:47Z","timestamp":1656967127000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S0899823X00194036\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2014,10]]},"references-count":28,"aliases":["10.1086\/677820"],"journal-issue":{"issue":"S3","published-print":{"date-parts":[[2014,10]]}},"alternative-id":["S0899823X00194036"],"URL":"https:\/\/doi.org\/10.1017\/s0899823x00194036","relation":{},"ISSN":["0899-823X","1559-6834"],"issn-type":[{"value":"0899-823X","type":"print"},{"value":"1559-6834","type":"electronic"}],"subject":[],"published":{"date-parts":[[2014,10]]}}}