Implementation of a Quality Improvement Initiative to Optimize Testing and Improve Antibiotic Utilization for Group A Streptococcal Pharyngitis in a Community Pediatric Practice

Abstract

Background and Objective: Acute pharyngitis is a common diagnosis in ambulatory pediatrics. The Infectious Diseases Society of America (IDSA) clinical practice guideline for group A streptococcal (GAS) pharyngitis recommends strict criteria for GAS testing to avoid misdiagnosis and unnecessary treatment of colonized children. We sought to improve adherence to the IDSA guideline for testing and treatment of GAS pharyngitis in a large community pediatrics practice. Methods: The Model for Improvement was used and iterative Plan-Do-Study-Act (PDSA) cycles were completed in a Maintenance of Certification quality improvement project. Interventions included: provider education, modification of an existing office procedure, communication strategies, and patient/family education. Outcomes were assessed utilizing statistical process control charts. Results: Unnecessary GAS testing decreased by 17% (from 64% to 47%) during the project. Presence of viral symptoms was the primary reason for unnecessary testing. Appropriate antibiotic utilization did not significantly change during the project. At the end of the intervention period the majority of providers perceived an improvement had occurred in their ability to communicate with families about the need for GAS pharyngitis testing and about antibiotic use. Conclusions: The majority of GAS pharyngitis testing in this practice was inconsistent with guideline recommendations for testing prior to intervention. A Maintenance of Certification quality improvement initiative led to improvement in guideline-based testing for GAS pharyngitis.