Look-Back and Look-Forward Durations and the Apparent Appropriateness of Ambulatory Antibiotic Prescribing.

Ambulatory antibiotic stewards, researchers, and performance measurement programs choose different durations to associate diagnoses with antibiotic prescriptions. We assessed how the apparent appropriateness of antibiotic prescribing changes when using different look-back and look-forward periods. Examining durations of 0 days (same-day), −3 days, −7 days, −30 days, ±3 days, ±7 days, and ±30 days, we classified all ambulatory antibiotic prescriptions in the electronic health record of an integrated health care system from 2016 to 2019 (714,057 prescriptions to 348,739 patients by 2391 clinicians) as chronic, appropriate, potentially appropriate, inappropriate, or not associated with any diagnosis. Overall, 16% percent of all prescriptions were classified as chronic infection related. Using only same-day diagnoses, appropriate, potentially appropriate, inappropriate, and not-associated antibiotics, accounted for 14%, 36%, 22%, and 11% of prescriptions, respectively. As the duration of association increased, the proportion of appropriate antibiotics stayed the same (range, 14% to 18%), potentially appropriate antibiotics increased (e.g., 43% for −30 days), inappropriate stayed the same (range, 22% to 24%), and not-associated antibiotics decreased (e.g., 2% for −30 days). Using the longest look-back-and-forward duration (±30 days), appropriate, potentially appropriate, inappropriate, and not-associated antibiotics, accounted for 18%, 44%, 20%, and 2% of prescriptions, respectively. Ambulatory programs and studies focused on appropriate or inappropriate antibiotic prescribing can reasonably use a short duration of association between an antibiotic prescription and diagnosis codes. Programs and studies focused on potentially appropriate antibiotic prescribing might consider examining longer durations.

门诊抗生素管理专家、研究人员以及绩效评估项目会选择不同的时长来将诊断与抗生素处方相关联。我们评估了在使用不同的回顾期和前瞻期时，抗生素处方的合理性表象如何变化。通过检查0天（当日）、−3天、−7天、−30天、±3天、±7天和±30天这些时长，我们将2016年至2019年某综合医疗保健系统电子健康记录中的所有门诊抗生素处方（2391名临床医生给348739名患者开具的714057份处方）分类为慢性、合理、可能合理、不合理或与任何诊断无关。总体而言，所有处方中有16%被归类为与慢性感染相关。仅使用当日诊断时，合理、可能合理、不合理以及与诊断无关的抗生素处方分别占14%、36%、22%和11%。随着关联时长的增加，合理抗生素的比例保持不变（范围为14% - 18%），可能合理的抗生素比例增加（例如，−30天时长时为43%），不合理的比例保持不变（范围为22% - 24%），与诊断无关的抗生素比例下降（例如，−30天时长时为2%）。使用最长的回顾和前瞻时长（±30天）时，合理、可能合理、不合理以及与诊断无关的抗生素处方分别占18%、44%、20%和2%。关注合理或不合理抗生素处方的门诊项目和研究可以合理地使用抗生素处方与诊断代码之间较短的关联时长。关注可能合理的抗生素处方的项目和研究可能需要考虑检查更长的时长。