Pilot Dissemination of a Realtime, Statewide, Pediatric Outpatient Antimicrobial Stewardship Dashboard
Authors: Kilgore Jacob T , Lanata Mariana M , Holthaus Brandi , Willis Jonathan M , McCarthy Michael J , Anderson Tess , Becker James B , Samples Borden , Sparks Jennifer , Evans Joseph E , Wattles Bethany , Smith Michael J 
Published: January 2025

Abstract

No conflicts of interest.
Corresponding author: Jacob T. Kilgore, MD, MPH, FAAP, Assistant Professor, Department of Pediatrics, Division of Pediatric Infectious Diseases, Marshall University Joan C. Edwards School of Medicine (MU-JCESOM), Hoops Family Children’s Hospital at Cabell Huntington Hospital, Marshall Health Network, 1600 Medical Center Drive, Suite 3500, Huntington, WV 25701-3655, Email: kilgore14@marshall.edu / Phone: 304.691.1367 (office) / 304.634.2448 (cell)
Alternate Corresponding author: Mariana Lanata, MD, FAAP, Associate Professor, Department of Pediatrics, Division of Pediatric Infectious Diseases, Marshall University Joan C. Edwards School of Medicine (MU-JCESOM), Hoops Family Children’s Hospital at Cabell Huntington Hospital, Marshall Health Network, 1600 Medical Center Drive, Suite 3500, Huntington, WV 25701-3655, Email: lanatapiazzo@marshall.edu / Phone: 304.691.1300 (office)
Funding sources: Pew Charitable Trusts grant, ID36391, JT Kilgore & MM Lanata co-PIs. Project: “Development and validation of a statewide Medicaid provider feedback dashboard for outpatient antibiotic prescribing in children.” (October 2022 – October 2024).
West Virginia Department of Health and Human Resources (WV DHHR) OEPS COVID SHARP grant, G221069, JT Kilgore & MM Lanata co-PIs. Project: “Creation and implementation of a statewide antimicrobial stewardship initiative.” (February 2022 – July 2024).

Background
West Virginia (WV) continues to rank first nationally in per capita outpatient antibiotic prescription rates. To help reduce antimicrobial overuse and misuse throughout the state, we have used WV pediatric Medicaid pharmacy and medical claims data to analyze outpatient antimicrobial prescription practices to guide data-driven interventions. These have included regional and statewide educational sessions, conference presentations, interactive webinars, and the creation of a public website that offers tips and tools for guideline concordant prescribing (https://jcesom.marshall.edu/departments-divisions/pediatrics/wv-antimicrobial-awareness/). The primary aim of current work is to pilot a dynamic electronic prescribing dashboard within a focus group of academic providers at Marshall Health. The results of this work will guide implementation of a real-time, statewide outpatient antimicrobial stewardship dashboard, the first of its kind according to literature review.

Methods
A focus group of pediatric and family medicine providers within Marshall Health Network who care for WV pediatric Medicaid patients was identified. This included a total of 82 health care professionals – 60 family practitioners (MD, DO, NP and PA) and 22 pediatricians (MD and DO only). Individualized prescription feedback was emailed to providers bimonthly. Reporting metrics included inappropriate diagnoses, guideline concordance, and cefdinir prescription rates for the individual provider as compared to peers. Inappropriate diagnoses described patient encounters where antibiotics were not warranted but were still prescribed. Guideline concordance was related to the antibiotic choice itself, assessing alignment with current IDSA and AAP guidelines for common outpatient pediatric diagnoses and management. Cefdinir prescription rates were included as cefdinir is a frequently prescribed, broad-spectrum antibiotic, yet it is not considered first line therapy for most common outpatient infections. After three iterations of email feedback, an anonymous provider survey assessing the quality and utility of the provider emails and research team website was sent to all included prescribers. This feedback is currently being integrated into the active construction of a real-time, statewide pediatric provider dashboard using Microsoft Power BI®.

Results
At the time of abstract submission, 7 (~9%) of the 82 Marshall Health Network focus group providers have responded to the feedback survey. 6 of 7 providers confirmed the emails and accompanying data had practice impact with 7 of 7 citing the “pediatric treatment cards,” a consolidated antibiotic reference for common outpatient diagnoses, as being most helpful. The dashboard currently includes an interactive interface with links to deidentified prescriptions rates and demographics, diagnosis-based prescriptions, and guideline concordant prescriptions (Figures 1 & 2). Concurrent construction of a password protected version that permits providers to view personal prescription metrics in comparison to deidentified peer data from the entire state is ongoing. Statewide dissemination is being supported by the West Virginia Department of Health & Human Resources (WV DHHR). Dissemination includes use of prescriber emails within the Medicaid database, multiple upcoming local, regional, and statewide conference presentations, and a link within the already established research team website.

Conclusion
A multipronged dissemination plan will be critical to the ultimate effectiveness of the dashboard. Support at the institutional and state level is invaluable in this process. Prescriber engagement is equally important for maximal impact and sustainability. These data are key to development of a tailored dashboard where Medicaid prescribers are the primary end user.

Figure 1. Electronic dashboard “Home” page

Figure 2. Electronic dashboard “Rates by Age” overlayed with “Guideline Concordance”