Management by Primary Care Clinicians of Patients Suspected of Having Community-Acquired Methicillin-Resistant Staphylococcus Aureus Infections

Final Contract Report

The Agency for Healthcare Research and Quality's Practice-Based Research Networks in Colorado conducted a 2-year project related to infections caused by community acquired methicillin-resistant Staphylococcus aureus. "Management by Primary Care Clinicians of Patients Suspected of Having Community-Acquired Methicillin-Resistant Staphylococcus Aureus Infections" is the final contract report for the project.

Prepared for the Agency for Healthcare Research and Quality (AHRQ) by the State Network of Colorado Ambulatory Practices and Partners under Contract No. HHSA-290-2007-10008.

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Prepared by: State Network of Colorado Ambulatory Practices and Partners

Contents

Background
Aims
Project Setting
Methods
    Data Sources
    Analysis
          Primary Outcomes (Electronic Chart Audit Data)
          Patient Follow-Up Data
          Provider Quality Improvement Case Reports
          Manual Chart Audits
Results
    Intervention Design
    Primary Outcomes
          Univariate Analysis of SSTIs
          Multivariate Analyses
          Assessment of Hawthorne Effect
    Patient Follow-Up Data
    Provider QI Case Reports
          Management and Treatment of Abscesses
          Management and Treatment of Cellulitis
    Manual Chart Audit
Discussion
      Primary Outcomes
      Patient Follow-Up
      Provider QI Case Reports
      Manual Chart Audit
Limitations
    Data Extraction
    Intervention
Lessons Learned
    Management of Skin and Soft Tissue Infections
    Electronic Data Extraction
Conclusions
References

Tables

Table 1. Manual chart audit data (pre-intervention baseline only)
Table 2. Intervention components in each health system
Table 3. Characteristics of all SSTI cases (680.x-682.x) in both health systems
Table 4. Pre-intervention and intervention rates for procedures and cultures of purulent SSTIs (680.x)
Table 5. Proportion of S. aureus cultures that were MRSA
Table 6. Antibiotic usage for purulent cases (680.x) and if MRSA-covering antibiotic
Table 7. Antibiotic usage for 681.x-682.x cases and if MRSA-covering antibiotic
Table 8. Antibiotic usage for all SSTI (680.x-682.x) cases and if MRSA-covering antibiotic
Table 9. Odds ratio estimates for procedures performed on purulent SSTIs (680.x)
Table 10. Odds ratios for cultures obtained on purulent SSTIs (680.x)
Table 11. Among 680.x cases, odds ratios for receiving antibiotics
Table 12. Among all cases (680-2.x), odds ratios for receiving antibiotics
Table 13. 680.x cases only, odds ratios for receiving a MRSA-covering antibiotic
Table 14. Among all cases 680.x-682.x, odds ratios for receiving a MRSA-covering antibiotic
Table 15. If an antibiotic was prescribed (680.x-682.x cases), odds ratios for receiving a MRSA-covering antibiotic (model excludes cases in which no antibiotic was prescribed)
Table 16. Among 681.x-682.x cases, odds ratios for prescribed antibiotics and prescribed MRSA-covering antibiotics
Table 17. Hawthorne Effect, purulent (680.x) intervention cases only
Table 18. Hawthorne Effect, 681.x and 682.x intervention cases only
Table 19. Characteristic of patients who completed quality improvement calls
Table 20. Follow-up status following initial management of SSTI
Table 21. Characteristics of patients seen with SSTI diagnosis in QI case reports
Table 22. Number of qualitative provider interview cases by infection type
Table 23. Antibiotics prescriptions by interviewed providers
Table 24. Type of antibiotic prescribed
Table 25. Manual chart audit results, including pre-intervention and intervention periods

Figures

Figure 1. 680.x Skin infections and antibiotic prescribing rates in WHA, MCNT, and combined
Figure 2. 681.x�682.x Skin infections and antibiotic prescribing rates in WHA, MCNT, and combined

Disclaimer

The findings and conclusions in this document are those of the author(s), who are responsible for its content, and do not necessarily represent the views of the Agency for Healthcare Research and Quality (AHRQ). No statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.

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Copyright

This document is in the public domain and may be used and reprinted without permission. AHRQ appreciates citation of the source.

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