Client:  A 28-location, multi-state hybrid primary care/urgent care center with 250 clinicians.

Challenge:  When children suffer from upper respiratory infections (URIs), parents often expect to leave the doctor’s office with an antibiotic prescription. But antibiotics are ineffective against the viruses that cause most URIs. Taking antibiotics unnecessarily helps bacteria develop resistance, a deadly consequence that affects the entire population.

Solution: The center wanted to improve the number of patients receiving appropriate care for URI. Discussion with clinicians revealed parents ask for antibiotics and some clinicians are uncomfortable saying antibiotics are an inappropriate treatment for URI. HQI practice improvement experts developed clinician scripts and educational materials about antibiotics. The center saw a modest increase in performance after adopting these resources. Further improvement cycles and discussion resulted in a decision to try providing antibiotic prescriptions that could be filled three days after the patient’s appointment, when URI symptoms typically have subsided.

Results: Most antibiotic prescriptions were not filled, resulting in more than 24% improvement compared to baseline over a 30-month period and culminating in performance above the Merit-based Incentive Payment System (MIPS) registry benchmark. The center made the “prescription pause” a permanent feature of e-prescribing antibiotics for URIs.

Sponsor:  This project was funded by the Centers for Medicare & Medicaid Services (CMS) through the Transforming Clinical Practices Initiative’s Practice Transformation Network program. HQI has conducted additional antibiotic stewardship projects with nursing homes and hospitals that were funded by other CMS programs and the Agency for Healthcare Research and Quality.