Journal article
Mixed-method evaluation of interactive provider dashboards for comparison of outpatient antibiotic prescribing for respiratory and otic conditions in walk-in clinics
Antimicrobial stewardship & healthcare epidemiology : ASHE, Vol.6(1), e128
05/01/2026
DOI: 10.1017/ash.2026.10365
PMID: 42130505
Appears in UI Libraries Support Open Access
Abstract
Objective: We evaluated how antibiotic use changed after implementation of a multifaceted intervention that sent providers individualized peer-comparison feedback on their antibiotic use for respiratory conditions that do not warrant antibiotics (never-events). Design: An interrupted time-series analysis was performed with a baseline (January 2018–January 2020) and intervention period (November 2021–December 2023), while controlling for COVID-19 era (February 2020–February 2022). Setting: Walk-in ambulatory clinics. Participants: Providers caring for patients in walk-in clinics. Methods: We conducted a mixed-methods study across 7 walk-in clinics in one health system. We included data from visits from 2018–2023 and conducted 17 semi-structured interviews with 10 providers. Results: After intervention implementation, antibiotic use for all visits decreased 8% (RR 0.92, 95% CI 0.86–0.97), then began to increase by 1% per month (RR 1.01, 95% CI 1.00–1.01). Once the intervention started, the use of never-event diagnostic codes decreased by 24% (RR 0.69–0.83) and continued to decrease by 1% per month (RR 0.99, 95% CI 0.98–0.99). Antibiotic use for never-event visits showed no immediate change after the intervention started (RR 0.80, 95% CI 0.61–1.04), then decreased by 3% per month (RR 0.97, 95% CI 0.96–0.98). Some providers valued receiving feedback on the metric; others admitted to shifting their codes. Conclusions: Delivering feedback to walk-in clinic providers was associated with temporary reductions in antibiotic-prescribing across all visits but also changes in diagnostic coding (ie, “gaming”). Antibiotic stewardship programs should monitor for changes in both when implementing new outpatient metrics.
Details
- Title: Subtitle
- Mixed-method evaluation of interactive provider dashboards for comparison of outpatient antibiotic prescribing for respiratory and otic conditions in walk-in clinics
- Creators
- Kelly M Percival - University of IowaKimberly C Dukes - University of IowaGosia S Clore - University of IowaStacey Hockett Sherlock - University of IowaDilek Ince - University of IowaNathan Shaw - University of IowaPatrick M Kinn - University of IowaLukasz Weiner - University of Iowa, Infectious Disease (Pediatrics)Christina Kopp - University of IowaMary Vaughan Sarrazin - University of Iowa, General Internal MedicineDaniel J Livorsi - University of Iowa
- Resource Type
- Journal article
- Publication Details
- Antimicrobial stewardship & healthcare epidemiology : ASHE, Vol.6(1), e128
- DOI
- 10.1017/ash.2026.10365
- PMID
- 42130505
- ISSN
- 2732-494X
- eISSN
- 2732-494X
- Publisher
- Cambridge University Press
- Grant note
- Centers for Disease Control (CDC) EpiCenters Program
This work was supported by the Centers for Disease Control (CDC) EpiCenters Program grant to the University of Iowa. CDC colleagues did not participate in manuscript preparation, submission, or review.
- Language
- English
- Date published
- 05/01/2026
- Academic Unit
- Infectious Diseases; Health Management and Policy; Stead Family Department of Pediatrics; Family and Community Medicine; General Internal Medicine; Community and Behavioral Health; Infectious Disease (Pediatrics); Internal Medicine
- Record Identifier
- 9985161443602771
Metrics
1 Record Views