Objective: This quality improvement effort aimed to increase the proportion of shorter-duration prescriptions for acute otitis media (AOM) in patients aged at least 2 years from a baseline of 30% to 50% without using an electronic health record (EHR) alert.
Methods: The project was conducted in a large pediatric primary care network and used 2 plan-do-study-act cycles. Cycle 1 included updates to the electronic prescription orders of commonly used antibiotics to include shorter-duration "speed button" options. Cycle 2 combined education with clinician-specific performance feedback and clinical decision support in the form of a "preference list" of easily searchable, preconfigured electronic prescription orders with shorter durations. Weekly proportions of prescriptions for AOM with a duration of 7 days or fewer in children aged at least 2 years (primary measure) and a duration of fewer than 10 days in children aged less than 2 years (balancing measure) were analyzed. Interrupted time series models tested the association of interventions with observed changes in primary and balancing measures.
Results: The first intervention was ineffective at improving the primary measure. A combination of education, targeted feedback, and preconfigured prescription orders increased shorter-duration treatment courses for AOM by a factor of 2-fold to approximately 60% with an undesired small but statistically significant increase in the balancing measure (+1.8%).
Conclusion: A combination of education with feedback and in-line clinical decision support in the form of easily searchable, preconfigured prescription orders (EHR "preference list") was successful in increasing shorter-duration prescriptions for AOM in a large primary care network without an EHR alert.
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