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Ranji SR, Steinman MA, Shojania KG, et al. Closing the Quality Gap: A Critical Analysis of Quality Improvement Strategies (Vol. 4: Antibiotic Prescribing Behavior). Rockville (MD): Agency for Healthcare Research and Quality (US); 2006 Jan. (Technical Reviews, No. 9.4.)

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Closing the Quality Gap: A Critical Analysis of Quality Improvement Strategies (Vol. 4: Antibiotic Prescribing Behavior).

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Appendix DAntibiotic Abstraction Forms for Screening and Full-Text Review

Stage 1

1. Does this article report or evaluate the results of an intervention (whether performed by the investigators or not)?

  • Yes
  • No [exclusion]
  • Can't tell

2. Does the article involve quality improvement or a QI strategy?

  • Yes - involves quality improvement or a QI strategy
  • Yes - systematic review of evaluations of a QI strategy
  • No [exclusion]
  • Can't tell

***Only answer questions 3–5 if questions 1–2 were answered “Yes”***

3. Should this article proceed to full text review for this topic?

  • Yes - evaluates a QI strategy involving microbial use
  • No - ineligible topic (focussed on inpatient care, antimicrobial use in chronic disease, not related to antimicrobial use) [exclusion]
  • No - not an evaluation or not QI [exclusion]
  • Can't tell - need article
  • No - foreign language [exclusion]

4. What type of study design was used?

  • RCT or quasi-RCT
  • CBA* or ITS**
  • Cohort study; before-after or time series not meeting CBA* or ITS** definitions [exclusion]
  • Observational (e.g., cross-section, case-control) [exclusion]
  • Systematic review or meta-analysis
  • Economic or decision analysis, modeling [exclusion]
  • Non-research (commentary, review, news) [exclusion]
  • Qualitative research (e.g., focus groups) [exclusion]
  • Guideline or consensus statement [exclusion]
  • Can't tell (need article)

* CBA: Controlled Before After requires contemporaneous observation periods for control and intervention groups AND judgement that control represents a comparable group or setting.

** ITS: Interrupted Time Series requires statement of well-defined time period for intervention implementation AND data measurement for at least three time points before and after intervention.

NOTE: At this stage of triage, err on the side of inclusion if there is a reasonable chance the study is an RCT, CBA or ITS. Similarly, if there is a reasonable chance that the article is a systematic review, designate it as such so the article can be pulled.

5. What category of study question is addressed by the article?

  • Can antimicrobial prescribing for illnesses not requiring antimicrobial therapy be reduced?
  • Can the selection of antimicrobials for illnesses requiring antimicrobials be improved?
  • Can prescribing antimicrobials at the appropriate dose or duration of treatment be improved?
  • Unclear
  • Other (explain)
  • None of the above

Stage 2

1. Does this article merit full text abstraction?

  • Yes
  • No - not QI or not an evaluation of a QI strategy [exclusion]
  • No - ineligible study design (i.e., not RCT, CBA, or ITS) [exclusion]
  • No - excluded topic (focused only on inpatient care, antimicrobial use in chronic disease) [exclusion]
  • No - no eligible outcomes* [exclusion]
  • No - other [exclusion]

*Eligible outcomes include measures of antimicrobial prescribing, antimicrobial resistance, or health services utilization (as a marker of prescription use).

2. Does this article present data overlapping with another article?

  • Exclude this article as a duplicate publication (identify included citation being duplicated) [exclusion]
  • Include this article, but obtain listed citation to help with abstraction (e.g., separate methods paper; identify required citation )
  • No or N/A

3. Does abstraction of this study require information from methods or results reported in other citations?

  • Yes (specify)
  • No

4. Does the article report data for more than one comparison (i.e., should it be abstracted as more than one study)?

  • Yes (specify which comparison is being abstracted here and which others will be abstracted elsewhere)
  • No

5. What category of study question is addressed by the article?

  • Can antimicrobial prescribing for illnesses not requiring antimicrobial therapy be reduced?
  • Can the selection of antimicrobials for illnesses requiring antimicrobials be improved?
  • Can prescribing antimicrobials at the appropriate dose or duration of treatment be improved?
  • Can antimicrobial resistance be reduced?
  • Can adverse effects of antimicrobial prescribing (i.e., adverse drug events or clinical consequences) be reduced?
  • Can the costs associated with antimicrobial prescribing be reduced?
  • Can health services utilization be reduced via improving the antimicrobial prescribing process?
  • Other

6. Describe the QI strategy used and its salient features. [text box]

A) Study Setting and Participants

7. In what country did the study take place?

  • US
  • non-US (specify)

8. When did the study take place?

  • If supplied, give exact dates of study period (beginning to end of intervention period)
  • Not reported

9. Who or what was targeted by the intervention? (check all that apply)

  • Patients
  • Providers (i.e., individual clinicians)
  • Entire population of a geographic area
  • Other (describe)

10. If the intervention targeted providers, in what setting did they practice? (check all that apply)

  • Outpatient primary care clinic (specify type of clinic, e.g., academic, VA, HMO)
  • Urgent care or walk-in clinic
  • Emergency department
  • Other (describe)
  • Not stated or not clear

12. Which specific disease process was the target of the antimicrobial intervention? (check all that apply)

  • Respiratory tract infection (specify)
  • Urinary tract infection
  • Sexually transmitted disease (e.g., gonorrhea/chlamydia, syphilis)
  • Gynecologic infection (e.g., vaginitis)
  • Other infection(s) (describe)
  • No specific disease targeted

13. Were patients in the study selected on the basis of specific demographic or clinical characteristics? (check all that apply)

  • Children (specify age groups)
  • Elderly (specify age groups)
  • Immunocompromised patients (specify)
  • Specific type of insurance (i.e., patients within a particular HMO) (describe)
  • Other demographic or clinical characteristic (describe)
  • No specific patient population targeted

14. What type of intervention was provided to the control population?

  • No intervention or usual care
  • Some form of low intensity intervention (describe)
  • No true control - just two or more different types of intervention (discuss with other reviewers; study may need to be excluded)

B) Study Design

15. What was the study design?

  • Randomized trial (state method of randomization if described)
  • Quasi-randomized trial (state basis for treatment allocation, e.g., alternating patients, calendar date, even or odd identification numbers)
  • Controlled before-after study*
  • Interrupted time series**

*Controlled Before After (CBA) requires contemporaneous observation periods for control and intervention groups AND judgment that control represents a comparable group or setting

** Interrupted time series (ITS) requires statement of well-defined time period for intervention implementation AND measurement of data at three or more time points both before and after intervention

16. What was the unit of randomization or treatment allocation?

  • Patient
  • Episode of care
  • Clinic day
  • Provider
  • Clinic or practice
  • Firm (describe)
  • Institution
  • Community
  • Other
  • Not applicable—ITS study (skip to question 27)

17. For the unit of treatment allocation above, state sample size in each group (If sample size differs for outcomes, detail differences in “Not stated or not clear” text box):

  • control group
  • intervention group
  • Not stated or not clear (explain)

18. If unit of analysis differed from unit of treatment allocation (e.g., providers randomized, but patient outcomes analyzed), state sample size in each group: (Use text box for “Not applicable” if sample size for any outcomes reported is different-give details)

  • control group
  • intervention group
  • Not stated or not clear
  • Not applicable (unit of analysis same as unit of treatment allocation above)

19. If unit of analysis differed from unit of treatment allocation, did authors acknowledge this issue and/or make appropriate adjustments?

  • Yes (describe)
  • No
  • Not applicable (unit of analysis did not differ from unit of treatment allocation)

20. Was there adequate concealment of treatment allocation?

  • Yes (unit of allocation was institution, team or professional and randomization process explicity described, OR unit of allocation was patient or episode of care and some form of centralized randomization scheme or sealed envelopes used)
  • Not clear (only partially meets above criteria) or not stated - specify which
  • No inadequate concealment (enrollment of patients in alternation or through use of even/odd identifying numbers OR unit of allocation was patient or episode of care and reported use of any allocation process that is entirely transparent before assignment (e.g., open list of random numbers) OR allocation was altered by investigators, professionals or patients)

21. Was informed consent obtained? (check all that apply)

  • Obtained from patients
  • Obtained from providers
  • Not obtained or not stated (specify)

22. Was IRB approval obtained by investigators?

  • Yes
  • No or not stated (specify)

Design criteria for randomized and quasi-randomized trials(If study is a CBA, skip to question 27; if ITS, skip to question 33)

25. Did the study have a cross over design? (Patients randomized to a sequence of interventions such as treatment A followed by treatment B in one group and treatment B followed by treatment A in the other group).

  • Yes (describe)
  • No
  • Not sure - clarify with other reviewers before proceeding

24. Were patients blind to intervention/treatment allocation?

  • Yes
  • No
  • Not sure (explain)
  • Not applicable (patients not actively involved in study - e.g., provider-focused intervention with patient level data obtained retrospectively from charts)

25. Were providers blind to intervention/treatment allocation?

  • Yes
  • No
  • Not sure (explain)
  • Not applicable (explain)

26. Were outcomes assessors blinded to intervention/treatment allocation?

  • Yes
  • No
  • Not sure (explain)
  • Not applicable (explain)

Design criteria for CBA trials

27. Were measurements in the control group performed at the same time as the intervention group?

  • Yes
  • No
  • Unclear

28. Were the criteria used for selecting the control site explained?

  • Yes (describe)
  • No

29. Was the control site comparable (in both patients and providers)?

  • Yes
  • No (explain why not)
  • Unclear (describe)

Design criteria for ITS trials

30. Was the intervention performed independent of other quality improvement efforts or other changes?

  • Yes
  • No
  • Unclear

31. Was the intervention unlikely to affect data collection?

  • Yes
  • No
  • Unclear

32. Was the data analyzed using a formal test for trend (time series ANOVA or regression)?

  • Yes
  • No
  • Unclear

33. (For all studies) Do any methodologic aspects of the study design not captured above seriously undermine appropriateness of inclusion?

  • Yes (explain)
  • No (use text box to document any non-fatal, but still noteworthy methodological features)

C) Quality Improvement Attributes of Intervention

34. Did the investigators identify a specific quality gap (a difference between optimal and actual care) in the study population?

  • Yes (describe)
  • No

35. Did the investigators cite previous literature to describe the evidence base for their proposed intervention?

  • Yes
  • No

36. Did the QI strategy involve PATIENT EDUCATION?

  • Yes
  • No patient education (skip to question 36)

37. Which of the following educational strategies was used? (check all that apply)

  • One-on-one session, in person or via telephone
  • Group session (e.g., classes)
  • Distribution of printed or audiovisual materials (e.g., pamphlets or poster in waiting room)
  • Community-wide mass media efforts (e.g., television advertisements or billboards)
  • Interactive computer-based learning
  • Provision of clinical data to patient (e.g., test results)
  • Not sure or other (describe)

38. In what setting was the educational content delivered? (check all that apply)

  • Clinical setting (e.g., office or emergency department)
  • Home (in person, by phone, mail or internet)
  • School or workplace
  • Other community setting (e.g., church, community center) (describe)
  • Mass media exposure
  • Other or unclear (describe)

39. Who was responsible for delivery of the educational content? (check all that apply)

  • Physician
  • Nurse or nurse practitioner
  • Pharmacist
  • Other ancillary health provider (describe)
  • Health educator
  • No specific delivery person (e.g., entirely mailed, computer-based, or passively distributed content)
  • Other (describe)

40. Did the intervention include access to a resource that promoted PATIENT SELF-MANAGEMENT?

  • Delayed prescriptions or other therapy based on patient self-monitoring of symptoms (describe)
  • Decision support for patient to use before seeing health care provider (e.g., access to a call center) (describe)
  • Other type of decision support (describe)
  • No

41. Did the QI strategy involve PROVIDER EDUCATION?

  • Yes
  • No (skip to question 42)

42. Which of the following educational strategies was used? (check all that apply)

  • Distribution of educational materials (published or printed recommendations for clinical care, including clinical practice guidelines, audio-visual materials and electronic publications)
  • Meetings or lectures (e.g., traditional CME)
  • Educational outreach visits (e.g.,“academic detailing”—a trained person who met with providers in their practice settings to give information with the intent of changing the provider's practice)
  • Interactive in-person education (e.g., workshops or role-playing)
  • Computer- or internet-based interactive tutorials
  • Consensus-building sessions (e.g., for development of guideline)
  • Not sure or other (describe)

43. In what setting was the educational content delivered? (check all that apply)

  • Office, emergency department, or other clinical setting
  • Off-site meeting (e.g.,CME)
  • Other (describe)

44. Who was responsible for delivery of the educational content? (check all that apply)

  • Expert opinion leader (describe how selected)
  • Other physician (including colleagues)
  • Pharmacist
  • Pharmaceutical sales representative
  • Other (describe)
  • Not clear or not specified

45. Did the QI strategy involve a PROVIDER REMINDER system*?

  • Chart based decision support or reminder system*
  • Computer based reminder* or decision support*
  • Not sure
  • No or N/A

*Patient or provider encounter specific information, provided verbally, on paper or on a computer screen, which is intended to prompt provider to recall information at the time of the patient encounter (e.g., reminder that antibiotics are ineffective for the common cold)

46. Did the QI strategy involve provider AUDIT AND FEEDBACK*? (check all that apply)

  • feedback to individual provider (state if confidential)
  • feedback about clinic or practice performance only
  • Public reporting of performance data (state if individual data or data for a group or institution)
  • Benchmarking**
  • Not sure or other
  • No or N/A

*Any summary of clinical performance of health care over a specified period of time. E.g., the number of times over the last year a provider prescribed antimicrobials for bronchitis.

**Benchmarking refers to the provision of performance data from institutions or providers regarded as “leaders in the field.” These data provide targets for other providers and institutions to emulate.

47. Did the QI strategy involve ORGANIZATIONAL CHANGE?

  • Adding new members to team (e.g., adding a clinical pharmacist to clinic, or creation of a call center for patients) or creating multidisciplinary teams for patient care
  • Revision of professional roles among health professionals (e.g., nurse practitioner or pharmacist given prescribing authority)
  • Increased staffing without changes in roles (e.g., adding more nurses)
  • TQM/CQI - cycles of measurement of quality problems, design of interventions, implementation and re-measurement
  • Changes in medical records systems — e.g., changing from paper to computerized records, patient tracking systems
  • Communication and case discussion between distant health professionals (e.g., telemedicine)
  • Not sure or other (describe)
  • No or N/A

48. If the intervention involved changes to medical record systems, what type of change was instituted?

  • Change from paper to computerized records
  • Implementation of computerized provider order entry (CPOE)
  • New patient tracking system
  • Other (describe)
  • Not applicable - No change to medical record system

49. Did the intervention involve FINANCIAL INCENTIVES DIRECTED AT PROVIDERS?

  • Financial incentives for achievement of performance goals
  • Change in reimbursement system (i.e., capitation)
  • Other (describe)
  • No component of provider-directed financial incentives

50. Did the intervention involve REGULATORY CHANGES DIRECTED AT PROVIDERS?

  • Restriction of formulary to cover only certain antimicrobials
  • Authorization from another physician required to prescribe antimicrobial
  • Authorization from health plan required to prescribe antimicrobial
  • Restriction of access to pharmaceutical sales representatives
  • Other (describe)
  • No component of provider-directed regulatory changes

51. Did the intervention involve FINANCIAL OR REGULATORY INCENTIVES DIRECTED AT PATIENTS?

  • Additional charge (copayment) for specific antimicrobials
  • Additional charge (copayment) for visits or phone calls
  • Change in health insurance premiums
  • Other (describe)
  • No component of patient-directed financial or regulatory incentives

52. Did the intervention involve FINANCIAL OR REGULATORY INCENTIVES DIRECTED AT A PRACTICE OR HEALTH SYSTEM?

  • Yes (describe)
  • No component of health-system-directed financial or regulatory incentives

53. Did a clinical information system play a role in design or implementation of the intervention?

  • Identification and/or group allocation of eligible patients or providers
  • Reminders generated by existing clinical information system
  • Decision support at point of care (e.g., for provider order entry)
  • Facilitated communication between providers (e.g., generated emails between members of care team)
  • Audit data gathered from clinical information system to design QI strategy (e.g., audit and feedback, TQM, provider education, financial incentives)
  • Other
  • No role for a clinical information system

54. Use textbox to state any important study features or concerns not captured above.

D) Results

55. For unit of treatment allocation (e.g., clinics, providers, patients), were results reported for at least 80% of participants?

  • Yes (state %)
  • No (state %)
  • Not stated

56. If unit of analysis differed from unit of treatment allocation (e.g., providers randomized, but patient level outcomes analyzed), were results reported for at least 80% of participants?

  • Yes (state %)
  • No (state %)
  • Not stated or not clear
  • Not applicable (unit of analysis same as unit of treatment allocation)

57. What was the length of the study follow-up period? (describe)

58. What were the outcome types? (check all that apply)

  • Measure of antimicrobial use
  • Measure of antimicrobial resistance
  • Measure of clinical outcome of disease
  • Health services utilization (when used as a marker of antimicrobial use)
  • Adverse drug events
  • Cost
  • Patient or provider satisfaction with plan of care
  • Not sure or other

Measures of antimicrobial use

59. For studies reporting measures of antimicrobial use, what specific outcomes were measured? (check all that apply)

  • Total prescriptions for antimicrobials (overall and/or a specific antimicrobial or class) by an individual provider, practice or health care system
  • Total volume of antimicrobials used by a provider, practice, or health care system (e.g., number of defined daily doses of an antibiotic prescribed by a physician)
  • Percentage of patient visits resulting in an antimicrobial prescription (overall and/or use of a specific antimicrobial or class)
  • Rate of compliance to clinical guideline for antimicrobial prescription (including decision to prescribe antimicrobial, choice of antimicrobial, or dose/duration of therapy)
  • Other (describe)
  • No measurement of antimicrobial use (skip to question 69)

60. For studies reporting data in the form of total prescriptions for antimicrobial use, provide the following data for the CONTROL group; if data is missing, record “NR”

  • Exact units of measurement
  • Number of prescriptions prior to intervention
  • Number of prescriptions after intervention
  • Percentage change in number of prescriptions

61. For studies reporting data in the form of total prescriptions for antimicrobial use, provide the following data for the INTERVENTION group; if data is missing, record “NR”

  • Exact units of measurement
  • Number of prescriptions prior to intervention
  • Number of prescriptions after intervention
  • Percentage change in number of prescriptions

62. For studies reporting data in the form of total volume of antimicrobial prescribed, provide the following data for the CONTROL group; if data is missing, record “NR”

  • Exact units of measurement
  • Volume of antibiotic used prior to intervention
  • Volume of antibiotic used after intervention
  • Percentage change in volume of antibiotic used

63. For studies reporting data in the form of total volume of antimicrobial prescribed, provide the following data for the INTERVENTION group; if data is missing, record “NR”

  • Exact units of measurement
  • Volume of antibiotic used prior to intervention
  • Volume of antibiotic used after intervention
  • Percentage change in volume of antibiotic used

64. For studies reporting data in the form of percentage of visits resulting in an antimicrobial prescription, provide the following data for the CONTROL group; if data is missing, record “NR”

  • Percentage of visits resulting in an antimicrobial prescription prior to intervention
  • Percentage of visits resulting in an antimicrobial prescription after intervention
  • Absolute change in percentage (after - prior)

65. For studies reporting data in the form of percentage of visits resulting in an antimicrobial prescription, provide the following data for the INTERVENTION group; if data is missing, record “NR”

  • Percentage of visits resulting in an antimicrobial prescription prior to intervention
  • Percentage of visits resulting in an antimicrobial prescription after intervention
  • Absolute change in percentage (after - prior)

66. For studies reporting data in the form of adherence to a guideline for antimicrobial prescribing, provide the following data for the CONTROL group; if data is missing, record “NR”

  • Percent adherence prior to intervention
  • Percent adherence after intervention
  • Absolute change in percentage (after - prior)

67. For studies reporting data in the form of adherence to a guideline for antimicrobial prescribing, provide the following data for the INTERVENTION group; if data is missing, record “NR”

  • Percent adherence prior to intervention
  • Percent adherence after intervention
  • Absolute change in percentage (after - prior)

68. Provide the following data for other types of measurements of antibiotic use not abstracted above:

  • Type of measurement and units of measurement
  • Value in CONTROL group before intervention
  • Value in CONTROL group after intervention
  • Value in INTERVENTION group before intervention
  • Value in INTERVENTION group after intervention

Measures of antimicrobial resistance

69. For studies reporting measures of antimicrobial resistance, what specific outcomes were measured? (check all that apply)

  • Percentage of isolates of an organism resistant to an antimicrobial or class of antimicrobials
  • Percentage of patients infected with a resistant organism
  • Rate of treatment failure for a specific antimicrobial used to treat a specific condition
  • Other (describe)
  • No measurement of antimicrobial resistance (skip to question 79)

70. For studies reporting the percentage of isolates resistant to an antimicrobial, record the following data; if data is missing, record “NR”

  • Type(s) of organism
  • Active infection or colonizer
  • Antimicrobial (or class of antimicrobial) for which resistance was assessed

71. For studies reporting the percentage of isolates resistant to an antimicrobial, record the following data for the CONTROL group; if data is missing, record “NR”

  • Number of isolates before intervention
  • Percentage of isolates resistant to antimicrobial BEFORE intervention
  • Number of isolates after intervention
  • Percentage of isolates resistant to antimicrobial AFTER intervention
  • Change in percentage of resistant isolates (after - before)

72. For studies reporting the percentage of isolates resistant to an antimicrobial, record the following data for the INTERVENTION group; if data is missing, record “NR”

  • Number of isolates before intervention
  • Percentage of isolates resistant to antimicrobial BEFORE intervention
  • Number of isolates after intervention
  • Percentage of isolates resistant to antimicrobial AFTER intervention
  • Change in percentage of resistant isolates (after - before)

73. For studies reporting the percentage of patients infected with a resistant organism, record the following data for the CONTROL group; if data is missing, record “NR”

  • Number of patients evaluated before intervention
  • Percentage of patients with resistant organism BEFORE intervention
  • Number of patients evaluated after intervention
  • Percentage of patients with resistant organism AFTER intervention
  • Change in percentage of resistant isolates (after - before)

74. For studies reporting the percentage patients infected with a resistant organism, record the following data for the INTERVENTION group; if data is missing, record “NR”

  • Number of patients evaluated before intervention
  • Percentage of patients with resistant organism BEFORE intervention
  • Number of patients evaluated after inervention
  • Percentage of patients with resistant organism AFTER intervention
  • Change in percentage of resistant isolates (after - before)

75. For studies reporting the rate of treatment failure for a specific antimicrobial used to treat a specific condition, record the following data:

  • Type of condition
  • Antimicrobial or class of antimicrobial

76. For studies reporting the rate of treatment failure for a specific antimicrobial used to treat a specific condition, record the following data for the CONTROL group;

  • Number of treated patients before intervention
  • Rate of treatment failure (as a percentage) before intervention
  • Number of patients after intervention
  • Rate of treatment failure (as a percentage) after intervention
  • Change in rate of treatment failure (after - before)

77. For studies reporting the rate of treatment failure for a specific antimicrobial used to treat a specific condition, record the following data for the INTERVENTION group;

  • Number of treated patients before intervention
  • Rate of treatment failure (as a percentage) before intervention
  • Number of treated patients after intervention
  • Rate of treatment failure (as a percentage) after intervention
  • Change in rate of treatment failure (after - before)

78. Provide the following data for other types of measurements of antimicrobial resistance not abstracted above:

  • Type of measurement and units of measurement
  • Value in CONTROL group before intervention
  • Value in CONTROL group after intervention
  • Value in INTERVENTION group before intervention
  • Value in INTERVENTION group after intervention

Measures of disease outcomes

Note: measures of disease outcomes should be abstracted only if the study also has usable data for one of the primary outcomes (antimicrobial usage or antimicrobial resistance).

79. For studies reporting clinical disease outcomes, what specific outcomes were measured?

  • Subjective measure of disease severity (e.g., time to symptom resolution)
  • Objective measure of disease severity (e.g., symptom score)
  • Other (describe)
  • No measurement of disease outcomes (skip to question 82)

80. For studies reporting disease outcomes as subjective measures of disease severity, record the following data:

  • Definition of clinical outcome as supplied in article, including unit of measurement
  • Value for CONTROL group
  • Value for INTERVENTION group

81. For studies reporting disease outcomes as objective measures of disease severity, record the following data:

  • Definition of clinical outcome as supplied in article
  • Value for CONTROL group
  • Value for INTERVENTION group

Measures of health services utilization

Note: measurements of health services utilization should be abstracted only if the study also has usable data for one of the primary outcomes (antimicrobial usage or antimicrobial resistance).

82. For studies reporting on health services utilization, what specific outcomes were measured?

  • Percentage of patients requiring an initial visit with a health care provider
  • Percentage of patients requiring a follow-up visit with a health care provider (may include return visit to clinic or emergency department, or hospitalization)
  • Other (describe)
  • No measurement of health services utilization (skip to question 86)

83. For studies reporting the percentage of patients requiring an INITIAL visit with a health care provider, record the following data:

  • Percentage in CONTROL group
  • Percentage in INTERVENTION group
  • Absolute difference (intervention - control)

84. For studies reporting the percentage of patients requiring a FOLLOW-UP visit with a health care provider, record the following data:

  • Type of health care setting(s) at follow-up visit
  • Percentage in CONTROL group
  • Percentage in INTERVENTION group
  • Absolute difference (intervention - control)

85. For studies measuring health services utilization not captured above, record the measurement and results:

Measures of adverse events

Note: adverse events should be abstracted only if the study also has usable data for one of the primary outcomes (antimicrobial usage or antimicrobial resistance).

86. For studies reporting measures of adverse events related to antimicrobial use, how were the adverse events assessed?

  • Rate of adverse drug events (i.e., clostridium dificile colitis, rash or other allergic reaction)
  • Incidence of severe infections possibly due to undertreatment (e.g., bacteremia)
  • Other (describe)
  • No measurement of adverse events (skip to question 90)

87. For studies reporting the rate of adverse drug events, record the following data:

  • Specific type of ADE measured
  • Rate in CONTROL group
  • Rate in INTERVENTION group
  • Absolute difference (intervention - control)

88. For studies reporting the rate of severe infections possibly due to undertreatment, record the following data:

  • Specific type of infection measured
  • Rate in CONTROL group
  • Rate in INTERVENTION group
  • Absolute difference (intervention - control)

89. For studies reporting measurement of adverse events not captured above, record the measurement and results:

Measures of costs

Note: cost outcomes should be abstracted only if the study also has usable data for one of the primary outcomes (antimicrobial usage or antimicrobial resistance).

90. For studies reporting cost outcomes, what specific measures were used?

  • Total cost of antimicrobials to a practice, hospital, or health system
  • Cost of health services utilization
  • Other (describe)
  • No measurement of costs (skip to question 94)

91. For studies reporting the total cost of antimicrobials, record the following data:

  • Exact units of measurement
  • Total costs in CONTROL group before intervention
  • Total costs in CONTROL group after intervention
  • Total costs in INTERVENTION group before intervention
  • Total costs in INTERVENTION group after intervention
  • Cost difference before intervention (intervention - control)
  • Cost difference after intervention (intervention - control)
  • Net change in costs attributable to intervention (cost difference after - cost difference before)

92. For studies reporting the total cost of health services utilization, record the following data:

  • Exact units of measurement
  • Total costs in CONTROL group before intervention
  • Total costs in CONTROL group after intervention
  • Total costs in INTERVENTION group before intervention
  • Total costs in INTERVENTION group after intervention
  • Cost difference before intervention (intervention - control)
  • Cost difference after intervention (intervention - control)
  • Net change in costs attributable to intervention (cost difference after - cost difference before)

93. For studies reporting cost measurements not abstracted above, record the units of measurement and results:

Patient or provider satisfaction with care

Note: patient/provider satisfaction should be abstracted only if the study also has usable data for one of the primary outcomes (antimicrobial usage or antimicrobial resistance).

94. For studies reporting data on PATIENT satisfaction with care, provide the following data; if data is missing, record “NR”

  • No measurement of patient satisfaction
  • Percent satisfaction in CONTROL group after intervention
  • Percent satisfaction in INTERVENTION group after intervention
  • Absolute difference (intervention - control)

95. For studies reporting data on PROVIDER satisfaction with care, provide the following data; if data is missing, record “NR”

  • No measure of provider satisfaction
  • Percent satisfaction in CONTROL group after intervention
  • Percent satisfaction in INTERVENTION group after intervention
  • Absolute difference (intervention - control)

96. Use textbox to state any important results or study concerns not captured above.

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