P-849. Evaluation of Interactive Provider Dashboards for Comparison of Outpatient Antibiotic Prescribing for Respiratory and Otic Conditions in Urgent and Quick Care Clinics

Abstract Background Antibiotic overuse for viral respiratory conditions that never require antibiotics is common in the outpatient setting, especially walk-in clinics. We evaluated the effect of a multifaceted stewardship intervention, which included sending providers individualized peer comparison feedback reports on their antibiotic use for conditions that do not benefit from antibiotics (“never-events”). Methods We used mixed-methods to evaluate the intervention (Figure 1) in 8 walk-in clinics during a baseline period (Jan 2018-Oct 2021) and an intervention period (Nov 2021-Dec 2023). To analyze whether the intervention was associated with changes in antibiotic-prescribing across all visits (regardless of the diagnosis), we fit a generalized linear mixed model using a Poisson distribution and a log link, including random intercepts for physicians and adjustment for practice changes that occurred during the COVID-19 pandemic. Secondary outcomes included changes in the use of never-event diagnostic codes. In 2023, we conducted 17 semi-structured interviews with 10 providers about the acceptability of the metric in comparison to a new metric for all respiratory diagnoses. Results There were 445,349 visits; median age was 27 (IQR 18-44), and 61% were female (Table 1). After implementation of the intervention, the frequency of antibiotic-prescribing for all visits changed from 23.1% to 23.7% (p< 0.001), and the use of never-event codes changed from 12.0% to 8.5% (p< 0.001). In the adjusted analysis, the frequency of antibiotic-prescribing across all visits was 11% lower compared to before the intervention (RR 0.89, 95% CI 0.85-0.94), and the use of never-event diagnostic codes decreased by 24% relative to baseline (RR 0.76, 95% CI 0.70-0.82) (Table 2). Some providers valued receiving feedback on the metric while others admitted to shifting their codes to avoid metric detection (Table 3). Conclusion Delivering feedback to walk-in clinics providers on their antibiotic use was associated with reductions in antibiotic-prescribing across all visits but also changes in diagnostic coding (i.e., “gaming”). Antibiotic stewardship programs should monitor for changes in both when implementing new outpatient metrics. Disclosures All Authors: No reported disclosures