Category: Federal Forum Posters
Purpose: Asymptomatic bacteriuria (ASB) treatment, fluoroquinolone prescribing, and prolonged treatment duration generally indicates sub-optimal UTI management. Our healthcare system wishes to develop a provider-focused, audit-feedback dashboard to improve UTI management.
Development requires assessment of provider variability in diagnosis and treatment based on data retrievable from a medical records relational database. ASB is difficult to capture within the database and documentation requires chart review. This MUE will evaluate associations between ASB and database retrievable elements including urinalysis (UA) and urine culture (UC) orders, then establish criteria for operationalizing an audit-feedback reporting system, while providing a cross sectional review of outpatient UTI management.
Methods: A cross-sectional retrospective MUE will evaluate ASB treatment and UTI management over 2 years. All outpatient UA and UC orders, UTI-based ICD-CM 10 codes, and total visit counts for each provider will be extracted from a medical records database and used to identify cohorts. Antibiotics ordered between 2 days prior and 3 days after each UA, UC, or UTI diagnosis will be identified along with fluoroquinolone prescribing, UTI treatment duration, and clinical outcomes. Next, provider-specific rates of diagnostic test ordering, diagnoses, and UTI treatment measures will be calculated per 100 visits. Provider-variability will be expressed as median (+ IQR) values. A random sample of 20% of patients with bacterial growth on UC will be selected and manual chart review will establish ASB and UTI documentation. ASB treatment rates per 100 visits will be determined for each provider. Linear regression will evaluate the relationship between provider-specific rates of ASB treatment and the frequency of UA, UC, and UTI rates. MUE measures will include aggregate analysis of diagnosis and prescribing trends including ASB treatment and non-treatment, and 30-day UTI revisit, Clostridium difficile, and hospitalization rates. Recommendations for inclusion of specific UTI measures within the electronic dashboard will be developed.
Results: Not applicable
Conclusion: Not applicable
Suzette Rovelsky– Pharmacy Student, Regis University, Westminster, CO