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.
Percival et al. (Thu,) studied this question.