|Improving Antibiotic Use in Urgent Care Facilities|
|Clinicaltrials.gov identifier||recruitment status||First Posted||Last update posted|
|NCT03932708||Active, not recruiting||May 1, 2019||February 10, 2021|
This study will implement a comprehensive outpatient stewardship program targeting a large network of Urgent Care (UC) clinics within Intermountain Helathcare.
|Condition or Disease:||
Antibiotic Side Effect
|Intervention/treatment:||Behavioral: CDC Core Elements of Outpatient Stewardship|
This study will characterize baseline antibiotic prescribing practices throughout the
Leadership Commitment. Improving the use of antibiotics is a priority for IH leaders. IH
Action for Policy and Practice. Our bundle of stewardship interventions is based on prior
1. Commitment Posters: All UC clinics will display commitment posters demonstrating support
2. EHR Tools: With the input of our frontline clinicians and assistance of our internal EHR
3. Prescription Justification: Azithromycin is 2nd most common antibiotic prescribed in the
Tracking and Reporting. Using IH data analysts to access the Enterprise Data Warehouse,
The individual provider reports will focus on the following elements:
- Rate of antibiotics prescribed for respiratory encounter visits
- Percent of sinusitis, pharyngitis, and AOM (respiratory, tier 2) encounters that
- Percent of sinusitis and AOM visits receiving a delayed antibiotic prescription
- Percent of Tier 3 respiratory encounters in which an antibiotic was prescribed
- Diagnosis rate of sinusitis (adults) and AOM (children)
Each of the above reported elements will include the providers' data along with comparison
Daily huddles are a method to help teams focus on quality and safety. Huddle boards are
Education and Expertise. Our UC focused stewardship intervention will incorporate several key
Our patients will also be a target for an educational initiative. Currently, IH is involved
|Arms and interventions|
Experimental: Urgent Care Antibiotic Stewardship Intervention
All 38 urgent care clinics will implement CDC Core Elements of outpatient antibiotic stewardship as described above.
Behavioral: CDC Core Elements of Outpatient Stewardship
The intervention is described above and includes components of leadership, action of policy and practice, tracking and reporting, and education and expertise.
|Primary Outcome Measures:||
1. Antibiotic prescribing for respiratory encounters measured at the encounter level [ Time Frame: Intervention period is one year ]
Respiratory encounters are defined as an urgent care encounter for any ICD10 defined respiratory condition, excluding encounters with concomitant other infectious diseases codes.
|Secondary Outcome Measures:||
1. Antibiotic prescribing appropriateness in respiratory encounters [ Time Frame: Intervention period is one year ]
The secondary outcome of antibiotic appropriateness will also be measured at the encounter level and will be estimated two ways: (i) in terms of rate of guideline-recommended antibiotics among selected respiratory diagnoses, and (ii) in terms of rate of antibiotic prescribing among respiratory diagnoses where no prescribing should occur (i.e., rate of "inappropriate" antibiotics).
2. Diagnostic shifting [ Time Frame: Intervention period is one year ]
The secondary outcome of diagnostic shifting will be measured at the provider level and characterize changes in the types of diagnoses used during respiratory encounters.
3. Patient satisfaction [ Time Frame: Intervention period is one year ]
As data availability allows, a secondary outcome of patient satisfaction will be measured at the patient encounter level in terms of a validated, patient satisfaction score. Patient satisfaction will be assessed using the "rate your provider" question. This question asks patients to rate their provider on a scale of 1 - 10 (1 being the worst, 10 being the best). Patient satisfaction scores will be explored in patients that receive antibiotics for tier 2 and 3 respiratory conditions and those that do not receive antibiotics for tier 2 and 3 respiratory conditions.
|Ages Eligible for Study:||(Child, Adult, Older Adult)|
|Sexes Eligible for Study:||All|
|Accepts Healthy Volunteers:||Yes|
- Intermountain Healthcare "InstaCare" Clinics
- Intermountain Healthcare "KidsCare" Clinics
- Intermountain Healthcare "ConnectCare"
- Intermountain Healthcare Hospitals and Medical Centers
- All non-Intermountain Healthcare urgent care clinics
|Contacts and Locations|
|United States, Utah||Intermountain Medical Center||Murray|
|Sponsors and Collaborators|
|Intermountain Health Care, Inc.|
|Centers for Disease Control and Prevention|
|Principal Investigator :||Eddie Stenehjem, MD||Intermountain Health Care, Inc.|
|Responsible Party :||Intermountain Health Care, Inc.|
|ClinicalTrials.gov Identifier :||NCT03932708|
|Other Study ID Numbers :||1050982|
|First Posted :||May 1, 2019|
|Last Update Posted :||February 10, 2021|
|Last Verified :||February 2021|
Data (IPD) Sharing
|Plan to Share IPD:||No|
|Studies a U.S. FDA-regulated Drug Product:||No|
|Studies a U.S. FDA-regulated Device Product:||No|
|Keywords provided by Intermountain Health Care, Inc.:||
Antibiotic Stewardship Outpatient Antibiotic Stewardship
|Additional relevant MeSH terms :||