A team from Wake Forest University School of Medicine and Atrium Health has been approved for a $2.5 million funding award by the Patient-Centered Outcomes Research Institute (PCORI) to help improve antibiotic prescribing for children with acute respiratory tract infections in outpatient settings.
Jennifer Sullivan, M.D., M.P.H., senior vice president for strategic operations at Atrium Health and clinical professor of emergency medicine at Wake Forest University School of Medicine, will lead the 3 1/2-year project. Lisa Davidson, M.D., medical director of the Antimicrobial Support Network at Atrium Health and clinical associate professor of infectious diseases at Wake Forest University School of Medicine, is the co-lead.
“Inappropriate antibiotic prescribing for children is linked to an increased risk of adverse health events,” Sullivan said. “It’s also associated with a rise in antibiotic resistance as well as higher costs for patients and health care systems.”
According to Davidson, between 30% to 50% of all antibiotics prescribed for respiratory tract infections are inappropriate.
“Overprescribing puts patients at increased risk for side effects and more resistant infections in the future,” Davidson said.
To help address these concerns, the Atrium Health Children’s Optimal Outpatient Stewardship (AH-CHOOS) program is designed to improve appropriate antibiotic prescribing for pediatric patients from 6 months to 18 years of age who are diagnosed with an acute respiratory infection such as pneumonia, bronchitis and pharyngitis.
This project aims to improve antibiotic prescribing and stewardship by implementing findings from a PCORI-funded patient-centered comparative clinical effectiveness research (CER) study demonstrating that narrow-spectrum antibiotics were as effective as broad-spectrum antibiotics in treating acute respiratory tract infections among children, with fewer side effects.
Sullivan said the project will build on previous work at Atrium Heath in the greater Charlotte area. In 2017, an initiative - the Carolinas Health System Antibiotic Stewardship Empowerment Network (CHOSEN) - successfully decreased inappropriate antibiotic prescribing rates for viral infections by 17-20% across various outpatient settings.
“Our goal with AH-CHOOS is to build on the success of CHOSEN and extend the same benefit to children across the entire Atrium Health footprint,” Davidson said.
The project will expand from the greater Charlotte area to include multiple sites served by Atrium Health Floyd, Atrium Health Navicent and Atrium Health Wake Forest Baptist across North Carolina, South Carolina, Georgia and Alabama.
More than 2,000 physicians and advanced practice providers are expected to participate in the project, which will include multiple practice types including pediatrics, family medicine, urgent care, emergency departments and telehealth visits.
In 2023, there were more than 350,000 outpatient pediatric encounters at these sites for ear infections, pharyngitis, pneumonia and sinus infections.
Davidson said the program will include several tools to support providers such as enhanced electronic health records to improve prescribing, access to robust data reporting and education to improve best practices.
“We will promote evidence-based interventions and implementation strategies to support appropriate antibiotic prescribing,” Sullivan said. “By empowering providers to use antibiotics only when necessary and to use the narrowest-spectrum option recommendation, we hope to prevent the growing problem of drug-resistant infections and avoid many adverse side effects.”
Sullivan said the interventions will also focus on enhancing patient and caregiver awareness and engagement with their care, utilizing family advisor expertise to refine communication and program implementation.
The funding award has been approved pending completion of PCORI’s business and programmatic review and issuance of a formal award contract.
Atrium Health is a participant in PCORI’s Health Systems Implementation Initiative (HSII) and was selected for funding through a PCORI funding opportunity recruiting HSII participants to promote evidence-based practice, based on findings generated from PCORI-funded patient-centered CER. HSII aims to reduce the estimated 17-year gap between evidence publication and clinical application. This initiative recognizes health systems’ practical experience and real-world insights are crucial for sustainable, large-scale implementation of practice-changing findings in clinical care.
PCORI is an independent, nonprofit organization authorized by Congress with a mission to fund patient-centered comparative clinical effectiveness research that provides patients, their caregivers and clinicians with the evidence-based information they need to make better-informed health and health care decisions.
Media contact: Myra Wright, mgwright@wakehealth.edu