缩短急性中耳炎和社区获得性肺炎的门诊抗生素治疗疗程
Decreasing Ambulatory Antibiotic Treatment Duration for Acute Otitis Media and Community-Acquired Pneumonia.
文献信息
| PMID | 42772667 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Elysha L Pifko |
| 作者单位 | Division of Emergency Medicine, Department of Pediatrics, Nemours Children's Health, Wilmington, DE. Electronic address: Elysha.pifko@nemours.org. |
| 期刊 | Academic pediatrics |
| SCI 分区 | Q1 |
| IF | 3.2 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 耳科 |
中文摘要
背景与目的： 尽管有证据支持急性中耳炎和社区获得性肺炎的短疗程治疗，但许多患者仍接受较长疗程。目标是在9个月内，将初级保健、急诊科和紧急护理机构（横跨三个州）中短疗程抗生素治疗的比例从40%提高到80%。
方法： 这项质量改进计划于2022年6月至2025年3月进行。通过七个计划-执行-研究-行动（PDSA）循环实施干预措施，包括创建临床路径和电子健康记录工具及后续增强、教育、通过医生激励和组织目标对齐提供组织支持、数据共享、现场巡视（gemba walks）和正向强化。使用统计过程控制图分析结局指标（接受短疗程治疗的就诊百分比和平均治疗天数）、过程指标（使用医嘱套餐的就诊百分比）和平衡指标（治疗失败）随时间的变化。
结果： 共纳入51,056名患者，其中基线阶段18,040名，实施阶段33,016名。短疗程抗生素治疗比例从40%增加到88%，并在所有种族、族裔和儿童机会指数中均有改善（p<0.001）。基线时存在的微小差异进一步缩小。平均抗生素疗程从8天减少到5.9天，累计节省42,141个抗生素使用日。治疗失败率保持不变（5%，范围2.5%-7.8%）。
结论： 质量改进方法使两种常见儿科诊断在不同人口统计学特征中系统性地缩短了抗生素疗程。与组织目标对齐和数据共享被证明是促进大规模实践变革的有效策略。
临床试验注册： 不适用。
英文摘要
BACKGROUND AND OBJECTIVE: Despite evidence supporting short treatment duration for acute otitis media and community-acquired pneumonia, many patients receive longer courses. The aim was to increase the proportion of short duration antibiotic therapy from 40% to 80% within 9 months in primary care, emergency department, and urgent care settings spanning three states.
METHODS: This quality improvement initiative was conducted from June 2022 to March 2025. Interventions were implemented through seven plan-do-study-act cycles, including creation of a clinical pathway and electronic health record tools with subsequent enhancements, education, organizational support via physician incentivization and alignment with organizational goals, data sharing, gemba walks, and positive reinforcement. Change in the outcome (percentage of encounters receiving short duration therapy and the mean duration of therapy), process (percentage of encounters utilizing order panels) and balancing (treatment failure) measures over time were analyzed using statistical process control charts.
RESULTS: 51,056 patients were included, with 18,040 patients in the baseline and 33,016 in the implementation phase. Short duration antibiotic therapy increased from 40% to 88% and improved across all race, ethnicity, and child opportunity indices (p<0.001). Minimal baseline disparities were further attenuated. Mean antibiotic duration decreased from 8 to 5.9 days, saving 42,141 cumulative antibiotic days. Treatment failure remained unchanged (5%, range 2.5%-7.8%).
CONCLUSION: Quality improvement methodology led to system-wide decrease in antibiotic duration across demographics in two common pediatric diagnoses. Aligning with organizational goals and data sharing proved to be effective strategies to promote large-scale practice change.
CLINICAL TRIAL REGISTRATION: N/A.