{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T22:45:16Z","timestamp":1777070716232,"version":"3.51.4"},"reference-count":35,"publisher":"Oxford University Press (OUP)","issue":"9","license":[{"start":{"date-parts":[[2023,9,1]],"date-time":"2023-09-01T00:00:00Z","timestamp":1693526400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/100009633","name":"Eunice Kennedy Shriver National Institute of Child Health and Human Development","doi-asserted-by":"publisher","award":["K23HD099925"],"award-info":[{"award-number":["K23HD099925"]}],"id":[{"id":"10.13039\/100009633","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,9,27]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Antibiotics are often overprescribed for pediatric conjunctivitis. We implemented a system-level quality improvement (QI) intervention to reduce unnecessary ophthalmic antibiotic use.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>The multi-faceted intervention in Denver, CO comprised a clinical care pathway, nurse protocol modifications, electronic health record (EHR) changes, parent education materials, and clinician education. We evaluated children aged 6 months\u201317 years with conjunctivitis seen between November 2018 and December 2022. A multi-interrupted time series model evaluated the effectiveness of the intervention over three time periods: Pre-COVID, Pre-Intervention (November 2018\u2013February 2020), COVID, Pre-Intervention (March 2020\u2013March 2021), and Post-Intervention (April 2021\u2013December 2022). Fisher\u2019s exact tests compared treatment failure and healthcare utilization rates between time periods and among children receiving or not receiving ophthalmic antibiotics.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Among 6960 eligible encounters, ophthalmic antibiotic use was reduced by 18.8% (95% CI: 16.3, 21.3) from Pre-COVID, Pre-Intervention to Post-Intervention. During the Pre-Intervention period following the onset of COVID, a reduction of 16.1% (95% CI: 12.9, 19.3) was observed. Implementation of the intervention resulted in an additional 2.7% (95% CI: \u22120.4, 5.7) reduction in antibiotic prescribing, primarily in younger children (ages 6 months\u20135 years). The greatest reduction in prescribing occurred for nurse triage encounters with an 82.1% (95% CI: 76.8, 87.5) reduction in prescribing rates (92.6%\u201310.5%). Treatment failure occurred in 1301 (18.7%) children and was more common among children that received an ophthalmic antibiotic than those that did not (20.0 vs 17.9%; P\u2005=\u2005.03).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>The QI intervention significantly reduced ophthalmic antibiotic prescribing for pediatric conjunctivitis without increasing treatment failure rates or health care utilization.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/jpids\/piad065","type":"journal-article","created":{"date-parts":[[2023,9,11]],"date-time":"2023-09-11T23:49:17Z","timestamp":1694476157000},"page":"496-503","source":"Crossref","is-referenced-by-count":7,"title":["Reducing Ophthalmic Antibiotic Use for Non-severe Conjunctivitis in Children"],"prefix":"10.1093","volume":"12","author":[{"given":"Thresia","family":"Sebastian","sequence":"first","affiliation":[{"name":"Department of Pediatrics, Denver Health and Hospital Authority , Denver, Colorado , USA"},{"name":"Department of Pediatrics, University of Colorado School of Medicine , Aurora, Colorado , USA"},{"name":"Department of Pediatrics, Alameda Health System , Oakland, Calofornia , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Josh","family":"Durfee","sequence":"additional","affiliation":[{"name":"Center for Health Systems Research, Denver Health and Hospital Authority , Denver, Colorado , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6116-9016","authenticated-orcid":false,"given":"Nancy","family":"Wittmer","sequence":"additional","affiliation":[{"name":"Center for Health Systems Research, Denver Health and Hospital Authority , Denver, Colorado , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jessica","family":"Jack","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Denver Health and Hospital Authority , Denver, Colorado , USA"},{"name":"Department of Pediatrics, University of Colorado School of Medicine , Aurora, Colorado , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amy","family":"Keith","sequence":"additional","affiliation":[{"name":"Center for Health Systems Research, Denver Health and Hospital Authority , Denver, Colorado , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Timothy C","family":"Jenkins","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases and Department of Medicine, Denver Health and Hospital Authority , Denver, Colorado , USA"},{"name":"Division of Infectious Diseases and Department of Medicine, University of Colorado School of Medicine , Aurora, Colorado , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3016-3287","authenticated-orcid":false,"given":"Holly 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