Journal article
The Value of Electronically Extracted Data for Auditing Outpatient Antimicrobial Prescribing
Infection control and hospital epidemiology, Vol.39(1), pp.64-70
01/2018
DOI: 10.1017/ice.2017.250
PMID: 29283076
Abstract
OBJECTIVE The optimal approach to auditing outpatient antimicrobial prescribing has not been established. We assessed how different types of electronic data-including prescriptions, patient-visits, and International Classification of Disease, Tenth Revision (ICD-10) codes-could inform automated antimicrobial audits.
DESIGN Outpatient visits during 2016 were retrospectively reviewed, including chart abstraction, if an antimicrobial was prescribed (cohort 1) or if the visit was associated with an infection-related ICD-10 code (cohort 2). Findings from cohorts 1 and 2 were compared.
SETTING Primary care clinics and the emergency department (ED) at the Iowa City Veterans Affairs Medical Center.
RESULTS In cohort 1, we reviewed 2,353 antimicrobial prescriptions across 52 providers. ICD-10 codes had limited sensitivity and positive predictive value (PPV) for validated cases of cystitis and pneumonia (sensitivity, 65.8%, 56.3%, respectively; PPV, 74.4%, 52.5%, respectively). The volume-adjusted antimicrobial prescribing rate was 13.6 per 100 ED visits and 7.5 per 100 primary care visits. In cohort 2, antimicrobials were not indicated in 474 of 851 visits (55.7%). The antimicrobial overtreatment rate was 48.8% for the ED and 59.7% for primary care. At the level of the individual prescriber, there was a positive correlation between a provider's volume-adjusted antimicrobial prescribing rate and the individualized rates of overtreatment in both the ED (r=0.72; P<.01) and the primary care setting (r=0.82; P=0.03).
CONCLUSIONS In this single-center study, ICD-10 codes had limited sensitivity and PPV for 2 infections that typically require antimicrobials. Electronically extracted data on a provider's rate of volume-adjusted antimicrobial prescribing correlated with the frequency at which unnecessary antimicrobials were prescribed, but this may have been driven by outlier prescribers. Infect Control Hosp Epidemiol 2018;39:64-70.
Details
- Title: Subtitle
- The Value of Electronically Extracted Data for Auditing Outpatient Antimicrobial Prescribing
- Creators
- Daniel J Livorsi - University of Iowa, Internal MedicineCarrie M Linn - University of IowaBruce Alexander - Iowa City VA Medical CenterBrett H Heintz - University of Iowa, College of PharmacyTraviss A Tubbs - Iowa City VA Medical CenterEli N Perencevich - University of Iowa, General Internal Medicine
- Resource Type
- Journal article
- Publication Details
- Infection control and hospital epidemiology, Vol.39(1), pp.64-70
- Publisher
- United States
- DOI
- 10.1017/ice.2017.250
- PMID
- 29283076
- ISSN
- 0899-823X
- eISSN
- 1559-6834
- Language
- English
- Date published
- 01/2018
- Academic Unit
- Pharmacy; Psychiatry; Infectious Diseases; Epidemiology; Pharmacy Practice and Science; Internal Medicine
- Record Identifier
- 9983779294102771
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