Abstract：
OBJECTIVE: To assess whether a two-phase intervention was associated with improvements in antibiotic prescribing among nonhospitalized children with community-acquired pneumonia.
METHODS: In a large health care organization, a first intervention phase was implemented in September 2020 directed at antibiotic choice and duration for children 2 months through 17 years of age with pneumonia. Activities included clinician education and implementation of a pneumonia-specific order set in the electronic health record. In October 2021, a second phase comprised additional education and order set revisions. A narrow spectrum antibiotic (eg, amoxicillin) was recommended in most circumstances. Electronic health record data were used to identify pneumonia cases and antibiotics ordered. Using interrupted time series analyses, antibiotic choice and duration after phase one (September 2020-September 2021) and after phase two (October 2021-October 2022) were compared with a preintervention prepandemic period (January 2016-early March 2020).
RESULTS: Overall, 3570 cases of community-acquired pneumonia were identified: 3246 cases preintervention, 98 post-phase one, and 226 post-phase two. The proportion receiving narrow spectrum monotherapy increased from 40.6% preintervention to 68.4% post-phase one to 69.0% post-phase two (P < .001). For children with an initial narrow spectrum antibiotic, duration decreased from preintervention (mean duration 9.9 days, SD 0.5 days) to post-phase one (mean 8.2, SD 1.9) to post-phase two (mean 6.8, SD 2.3) periods (P < .001).
CONCLUSIONS: A two-phase intervention with educational sessions combined with clinical decision support was associated with sustained improvements in antibiotic choice and duration among children with community-acquired pneumonia.
METHODS: In a large health care organization, a first intervention phase was implemented in September 2020 directed at antibiotic choice and duration for children 2 months through 17 years of age with pneumonia. Activities included clinician education and implementation of a pneumonia-specific order set in the electronic health record. In October 2021, a second phase comprised additional education and order set revisions. A narrow spectrum antibiotic (eg, amoxicillin) was recommended in most circumstances. Electronic health record data were used to identify pneumonia cases and antibiotics ordered. Using interrupted time series analyses, antibiotic choice and duration after phase one (September 2020-September 2021) and after phase two (October 2021-October 2022) were compared with a preintervention prepandemic period (January 2016-early March 2020).
RESULTS: Overall, 3570 cases of community-acquired pneumonia were identified: 3246 cases preintervention, 98 post-phase one, and 226 post-phase two. The proportion receiving narrow spectrum monotherapy increased from 40.6% preintervention to 68.4% post-phase one to 69.0% post-phase two (P < .001). For children with an initial narrow spectrum antibiotic, duration decreased from preintervention (mean duration 9.9 days, SD 0.5 days) to post-phase one (mean 8.2, SD 1.9) to post-phase two (mean 6.8, SD 2.3) periods (P < .001).
CONCLUSIONS: A two-phase intervention with educational sessions combined with clinical decision support was associated with sustained improvements in antibiotic choice and duration among children with community-acquired pneumonia.
摘要：
目的：评估非住院儿童社区获得性肺炎两阶段干预是否与抗生素处方改善相关。
方法：在大型医疗保健组织中，针对2个月至17岁肺炎儿童的抗生素选择和持续时间,于2020年9月实施了第一阶段干预.活动包括临床医生教育和在电子健康记录（EHR）中实施针对肺炎的特定订单集。2021年10月，第二阶段包括额外的教育和订单调整。一种窄谱抗生素（如，在大多数情况下建议使用阿莫西林）。EHR数据用于识别肺炎病例和订购抗生素。使用中断的时间序列分析，将第一阶段(2020年9月至2021年9月)和第二阶段(2021年10月至2022年10月)后的抗生素选择和持续时间与大流行前干预期(2016年1月至2020年3月初)进行比较.
结果：总体而言，确定了3570例社区获得性肺炎：3246例干预前，98第一阶段后，第二阶段后226。接受窄谱单一疗法的比例从干预前的40.6％增加到第一阶段后的68.4％，再到第二阶段后的69.0％（p<0.001）。对于最初使用窄谱抗生素的儿童，持续时间比干预前减少(平均持续时间9.9天，标准偏差[SD]0.5天）至第一阶段后（平均8.2，SD1.9）至第二阶段后（平均6.8，SD2.3）期（p<0.001）。
结论：在社区获得性肺炎儿童中，两阶段干预与临床决策支持相结合，与抗生素选择和持续时间的持续改善有关。
方法：在大型医疗保健组织中，针对2个月至17岁肺炎儿童的抗生素选择和持续时间,于2020年9月实施了第一阶段干预.活动包括临床医生教育和在电子健康记录（EHR）中实施针对肺炎的特定订单集。2021年10月，第二阶段包括额外的教育和订单调整。一种窄谱抗生素（如，在大多数情况下建议使用阿莫西林）。EHR数据用于识别肺炎病例和订购抗生素。使用中断的时间序列分析，将第一阶段(2020年9月至2021年9月)和第二阶段(2021年10月至2022年10月)后的抗生素选择和持续时间与大流行前干预期(2016年1月至2020年3月初)进行比较.
结果：总体而言，确定了3570例社区获得性肺炎：3246例干预前，98第一阶段后，第二阶段后226。接受窄谱单一疗法的比例从干预前的40.6％增加到第一阶段后的68.4％，再到第二阶段后的69.0％（p<0.001）。对于最初使用窄谱抗生素的儿童，持续时间比干预前减少(平均持续时间9.9天，标准偏差[SD]0.5天）至第一阶段后（平均8.2，SD1.9）至第二阶段后（平均6.8，SD2.3）期（p<0.001）。
结论：在社区获得性肺炎儿童中，两阶段干预与临床决策支持相结合，与抗生素选择和持续时间的持续改善有关。
