Project Summary

PCORI implementation projects promote the use of findings from PCORI-funded studies in real-world healthcare and other settings. These projects build toward broad use of evidence to inform healthcare decisions.

This PCORI-funded implementation project is working to reduce rates of inappropriate antibiotic prescribing for children with acute respiratory tract infections.

Antibiotics are the most common medicines prescribed for children, but they are often overused. Inappropriate antibiotic use can cause unnecessary side effects and contribute to antibiotic resistance.

Implementation Project Summary

COVID-19-Related Project Enhancement

To reduce the risk of spreading the COVID-19 virus, many health systems are pausing in-person care. In its place, they are using telehealth. Telehealth provides care to patients remotely using phone, video, or monitoring devices that can help manage care.

To diagnose ARTIs in children, clinicians often use a physical exam or lab test that may not be possible with telehealth. As a result, clinicians may not prescribe appropriate antibiotics for ARTIs. With the enhancement, the project team will adapt the PARTI program for telehealth. The team will update:

  • Information about prescribing antibiotics for ARTIs during telehealth visits
  • Reports that clinicians receive to track telehealth prescribing

Enhancement Award Amount: $499,375*

What is the goal of this implementation project?

Antibiotics help fight infections caused by bacteria. Narrow-spectrum antibiotics target a few types of bacteria. Broad-spectrum antibiotics target many types. Using broad-spectrum antibiotics when they’re not needed can create antibiotic-resistant bacteria that are hard to treat. A PCORI-funded study found that narrow-spectrum antibiotics worked just as well as broad-spectrum antibiotics to treat ear, sinus, and throat infections in children; they also had fewer side effects like diarrhea and vomiting. But clinicians still prescribe broad-spectrum antibiotics more than twice as often as they’re needed.

This project is using a multi-part program to improve antibiotic prescribing at healthcare visits for children with ear, sinus, and throat infections. The program is called Prescribing Antibiotics for Respiratory Tract Infections, or PARTI.

What will this project do?

The project team is rolling out PARTI at 115 sites across five health systems in three states. The sites include primary care, family, and urgent care practices. Sites also include emergency departments, or EDs.

The project team is working with sites to put PARTI in place. The team is

  • Adapting PARTI educational materials to reflect updated evidence on broad- and narrow-spectrum antibiotics
  • Creating three 30-minute online modules to teach clinicians about appropriate prescribing and communicating with parents
  • Providing feedback reports that compare clinicians’ own prescribing rates to others within and across sites
  • Working with sites to set up systems that can extract data on prescribing for clinician feedback reports
  • Providing ongoing support at each site, including through site visits

What is the expected impact of this project?

The project will show what’s required to put programs in place to improve antibiotic prescribing for children who visit primary care, family, and urgent care practices and the ED. The project evaluation will confirm whether PARTI is working as intended.

This project will involve at least 900 clinicians who see about 357,000 children with ear, sinus, and throat infections each year. Sites have committed to maintaining PARTI after the project ends

More about this implementation project:

Stakeholders Involved in This Project

  • Children’s Hospital of Philadelphia Family Advisory Council
  • American Academy of Pediatrics
  • Pediatric Research in Office Settings network

Implementation Strategies

  • Develop online education modules for clinicians
  • Provide sites with ongoing support through on-site visits and follow-up facilitation activities
  • Offer continuing education credits to physicians and nurse practitioners
  • Train site practice champions and systems leaders to serve as internal facilitators
  • Work with IT staff to extract patient data from the electronic health record for audit and feedback reports
  • Deliver electronic audit and feedback reports to frontline prescribers

Evaluation Outcomes

To document implementation:

  • Number of clinicians who complete online education
  • Number of children seen by participating sites
  • Use of audit and feedback reports by clinicians
  • Additional measures of feasibility, acceptability, fidelity of program delivery, and maintenance
  • Implementation barriers and facilitators

To assess healthcare and health outcomes:

  • Rates of appropriate antibiotic prescribing 

Project Information

Jeffrey Gerber, MD, PhD
The Children's Hospital of Philadelphia
$2,997,927

Key Dates

36 months
November 2019
March 2024
2019

Study Registration Information

Initial PCORI-funded Research Study

This implementation project focuses on putting findings into practice from this completed PCORI-funded research study: Comparing Broad- and Narrow-Spectrum Antibiotics for Children with Ear, Sinus, and Throat Infections

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Last updated: November 5, 2021