{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T18:02:24Z","timestamp":1791396144226,"version":"4.3.3"},"reference-count":40,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T00:00:00Z","timestamp":1780444800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,10,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The Healthcare Effectiveness Data and Information Set\u2019s antibiotic utilization for respiratory conditions (AXR) is a new, broad antibiotic prescribing metric. Higher AXR values indicate higher respiratory encounter prescribing rates. Relationships between clinician-level AXR and prescribing\/diagnostic practices are unclear.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This was a retrospective observational study of respiratory urgent care (UC) encounters across 32 UC centers in our health system, conducted from 1 July 2022 to 30 June 2025. Correlations between clinician-level AXR and prespecified outcomes (tier 3 prescribing, antibiotics for pharyngitis despite negative group A Streptococcus antigen testing, sinusitis\/acute otitis media (AOM) treatment\/diagnosis rates, narrow-spectrum antibiotic prescriptions excluding encounters with penicillin allergy, and &amp;lt;7-day treatment duration for sinusitis\/AOM in patients \u22652 years) were assessed using quartile-based logistic regression and weighted Spearman correlations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 528 444 respiratory encounters, 37.1% (195 891) were associated with an antibiotic prescription; 303 clinicians were included. Clinicians in the highest AXR quartile (AXR quartile 4 [Q4]) were more likely to be in Q4 than in quartile 1 for the following: tier 3 prescribing (odds ratio, 15.38 [95% confidence interval, 5.58\u201342.39]), pharyngitis prescribing despite negative group A Streptococcus testing (11.16 [4.04\u201330.79]), and the treatment (8.95 [3.23\u201324.80]) or diagnosis (33.92 [11.14\u2013103.27]) of sinusitis\/AOM. AXR-Q4 clinicians were less likely to be in Q4 for narrow-spectrum antibiotic prescriptions excluding encounters with penicillin allergy (odds ratio, 0.36 [95% confidence interval, .17\u2013.77]) and prescriptions of &amp;lt;7 days for sinusitis\/AOM for patients \u22652 years old (0.25 [.11\u2013.55]).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In our UC network, high clinician-AXR was correlated with antibiotic prescription\/diagnostic measures. AXR can serve as an efficient screening metric but should be paired with prescription\/diagnosis-specific measures and prescription characteristics to guide outpatient stewardship efforts.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/cid\/ciag255","type":"journal-article","created":{"date-parts":[[2026,4,14]],"date-time":"2026-04-14T11:27:34Z","timestamp":1776166054000},"page":"351-361","source":"Crossref","is-referenced-by-count":0,"title":["Check Engine Light, Red Herring, or MacGuffin? Clinician-Level Correlations of the Antibiotic Utilization for Respiratory Conditions (AXR) Metric With Outpatient Antimicrobial Stewardship Metrics, Diagnostic Practices, and Prescription Characteristics"],"prefix":"10.1093","volume":"83","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8142-3405","authenticated-orcid":false,"given":"Allan M","family":"Seibert","sequence":"first","affiliation":[{"name":"Division of Infectious Diseases, Intermountain Health , Salt Lake City, Utah ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0148-046X","authenticated-orcid":false,"given":"Adam L","family":"Hersh","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Pediatrics, University of Utah School of Medicine , Salt Lake City, Utah ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Park","family":"Willis","sequence":"additional","affiliation":[{"name":"Intermountain Urgent Care, Intermountain Health , Salt Lake City, Utah ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barbora","family":"Nelson","sequence":"additional","affiliation":[{"name":"Intermountain KidsCare, Intermountain Urgent Care, Intermountain Health , Salt Lake City, Utah ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3005-2878","authenticated-orcid":false,"given":"Joseph","family":"Bledsoe","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Intermountain Medical Center, Intermountain Health , Salt Lake City, Utah ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8666-7313","authenticated-orcid":false,"given":"Payal K","family":"Patel","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Intermountain Health , Salt Lake City, Utah ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9505-2572","authenticated-orcid":false,"given":"Whitney","family":"Buckel","sequence":"additional","affiliation":[{"name":"Intermountain Health Pharmacy Services , Salt Lake City, Utah ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jared A","family":"Olson","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Pediatrics, University of Utah School of Medicine , Salt Lake City, Utah ,","place":["USA"]},{"name":"Department of Pharmacy, Primary Children's Hospital , Salt Lake City, Utah ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6209-1740","authenticated-orcid":false,"given":"Nora","family":"Fino","sequence":"additional","affiliation":[{"name":"Division of Biostatistics, Department of Population Health Sciences, University of Utah Health , Salt Lake City, Utah ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-9701-1735","authenticated-orcid":false,"given":"Valoree","family":"Stanfield","sequence":"additional","affiliation":[{"name":"Office of Patient Experience, Intermountain Health , Salt Lake City, Utah ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9209-1226","authenticated-orcid":false,"given":"Alyssa Y","family":"Castillo","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, University of Colorado School of Medicine , Aurora, Colorado ,","place":["USA"]},{"name":"Antimicrobial Stewardship Program, University of Colorado Hospital , Aurora, Colorado ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3016-3287","authenticated-orcid":false,"given":"Holly M","family":"Frost","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Pediatrics, University of Utah School of Medicine , Salt Lake City, Utah ,","place":["USA"]},{"name":"Office of Research, Intermountain Health , Murray, Utah ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6065-9964","authenticated-orcid":false,"given":"Edward A","family":"Stenehjem","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Infectious Diseases, University of Colorado School of Medicine , Aurora, Colorado 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