Impact of a healthcare provider educational intervention on frequency of clostridium difficile polymerase chain reaction testing in children: A segmented regression analysis

Larry K. Kociolek; Maria Bovee; Donna Carter; Jody D. Ciolino; Rupal Patel; Anna O'Donnell; Angela H. Rupp; Xiaotian Zheng; Stanford T. Shulman; Sameer J. Patel

doi:10.1093/jpids/piw027

Impact of a healthcare provider educational intervention on frequency of clostridium difficile polymerase chain reaction testing in children: A segmented regression analysis

Larry K. Kociolek^*, Maria Bovee, Donna Carter, Jody D. Ciolino, Rupal Patel, Anna O'Donnell, Angela H. Rupp, Xiaotian Zheng, Stanford T. Shulman, Sameer J. Patel

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

24 Scopus citations

Abstract

Background. Although Clostridium difficile infections (CDIs) are increasingly diagnosed in children, many children diagnosed with CDI lack classic risk factors. Frequent use of highly sensitive tcdB polymerase chain reaction (PCR) testing in low-risk patients leads to CDI misdiagnosis and unnecessary CDI antibiotic use in children with C difficile carriage. Methods. For this quasi-experimental study, we developed and implemented an educational intervention (EI) to inform healthcare providers (HCPs) about tcdB PCR test limitations. We provided HCP didactic education and built an electronic notification into the tcdB PCR test order that describes scenarios in which carriage is more likely than CDI. Segmented regression analysis assessed changes in level (ie, overall rates) and trend of C difficile testing rate ([TR] number of tests performed per 1000 patient encounters) and test positivity rate ([PR] number of positive tests per 1000 patient encounters) between the pre- (August 2009-August 2013) and postintervention (February 2014-July 2015) periods. Results. Hospital-wide, absolute TR reduction was 0.71 (P[level] = .0067; P[trend] = .0042) and absolute PR reduction was 0.14 (P[level] = .22; P[trend] = .018). In the outpatient setting, absolute TR reduction was 0.30 (P[level] = .0015; P[trend] < .001) and absolute PR reduction was 0.09 (P[level] = .0069; P[trend] = .046). The incidence density of healthcare facility-associated CDI did not significantly change after the EI. The EI was associated with avoidance of 574 tests and 113 positive tests (and subsequent antibiotic courses) during the postintervention period, which saved approximately $250 000 in patient charges related to CDI testing and treatment. Conclusions. Healthcare provider education can cost-effectively reduce the frequency of C difficile testing and CDI misdiagnosis by improving test utilization among low-risk children.

Original language	English (US)
Article number	piw027
Pages (from-to)	142-148
Number of pages	7
Journal	Journal of the Pediatric Infectious Diseases Society
Volume	6
Issue number	2
DOIs	https://doi.org/10.1093/jpids/piw027
State	Published - Jun 1 2017

Funding

The project was supported by the National Center for Research Resources, Grant 5UL1RR025741, and is now at the National Center for Advancing Translational Sciences, Grant 8UL1TR000150. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

Keywords

Clostridium difficile
Colonization
Microbiology
Pediatric
Testing

ASJC Scopus subject areas

Infectious Diseases
Pediatrics, Perinatology, and Child Health

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.1093/jpids/piw027

Cite this

Kociolek, L. K., Bovee, M., Carter, D., Ciolino, J. D., Patel, R., O'Donnell, A., Rupp, A. H., Zheng, X., Shulman, S. T., & Patel, S. J. (2017). Impact of a healthcare provider educational intervention on frequency of clostridium difficile polymerase chain reaction testing in children: A segmented regression analysis. Journal of the Pediatric Infectious Diseases Society, 6(2), 142-148. Article piw027. https://doi.org/10.1093/jpids/piw027

@article{11b7de36a66e48349cc9159e34495766,

title = "Impact of a healthcare provider educational intervention on frequency of clostridium difficile polymerase chain reaction testing in children: A segmented regression analysis",

abstract = "Background. Although Clostridium difficile infections (CDIs) are increasingly diagnosed in children, many children diagnosed with CDI lack classic risk factors. Frequent use of highly sensitive tcdB polymerase chain reaction (PCR) testing in low-risk patients leads to CDI misdiagnosis and unnecessary CDI antibiotic use in children with C difficile carriage. Methods. For this quasi-experimental study, we developed and implemented an educational intervention (EI) to inform healthcare providers (HCPs) about tcdB PCR test limitations. We provided HCP didactic education and built an electronic notification into the tcdB PCR test order that describes scenarios in which carriage is more likely than CDI. Segmented regression analysis assessed changes in level (ie, overall rates) and trend of C difficile testing rate ([TR] number of tests performed per 1000 patient encounters) and test positivity rate ([PR] number of positive tests per 1000 patient encounters) between the pre- (August 2009-August 2013) and postintervention (February 2014-July 2015) periods. Results. Hospital-wide, absolute TR reduction was 0.71 (P[level] = .0067; P[trend] = .0042) and absolute PR reduction was 0.14 (P[level] = .22; P[trend] = .018). In the outpatient setting, absolute TR reduction was 0.30 (P[level] = .0015; P[trend] < .001) and absolute PR reduction was 0.09 (P[level] = .0069; P[trend] = .046). The incidence density of healthcare facility-associated CDI did not significantly change after the EI. The EI was associated with avoidance of 574 tests and 113 positive tests (and subsequent antibiotic courses) during the postintervention period, which saved approximately $250 000 in patient charges related to CDI testing and treatment. Conclusions. Healthcare provider education can cost-effectively reduce the frequency of C difficile testing and CDI misdiagnosis by improving test utilization among low-risk children.",

keywords = "Clostridium difficile, Colonization, Microbiology, Pediatric, Testing",

author = "Kociolek, {Larry K.} and Maria Bovee and Donna Carter and Ciolino, {Jody D.} and Rupal Patel and Anna O'Donnell and Rupp, {Angela H.} and Xiaotian Zheng and Shulman, {Stanford T.} and Patel, {Sameer J.}",

note = "Publisher Copyright: {\textcopyright} The Author 2016.",

year = "2017",

month = jun,

day = "1",

doi = "10.1093/jpids/piw027",

language = "English (US)",

volume = "6",

pages = "142--148",

journal = "Journal of the Pediatric Infectious Diseases Society",

issn = "2048-7193",

publisher = "Oxford University Press",

number = "2",

}

Kociolek, LK, Bovee, M, Carter, D, Ciolino, JD, Patel, R, O'Donnell, A, Rupp, AH, Zheng, X, Shulman, ST & Patel, SJ 2017, 'Impact of a healthcare provider educational intervention on frequency of clostridium difficile polymerase chain reaction testing in children: A segmented regression analysis', Journal of the Pediatric Infectious Diseases Society, vol. 6, no. 2, piw027, pp. 142-148. https://doi.org/10.1093/jpids/piw027

Impact of a healthcare provider educational intervention on frequency of clostridium difficile polymerase chain reaction testing in children: A segmented regression analysis. / Kociolek, Larry K.; Bovee, Maria; Carter, Donna et al.
In: Journal of the Pediatric Infectious Diseases Society, Vol. 6, No. 2, piw027, 01.06.2017, p. 142-148.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Impact of a healthcare provider educational intervention on frequency of clostridium difficile polymerase chain reaction testing in children

T2 - A segmented regression analysis

AU - Kociolek, Larry K.

AU - Bovee, Maria

AU - Carter, Donna

AU - Ciolino, Jody D.

AU - Patel, Rupal

AU - O'Donnell, Anna

AU - Rupp, Angela H.

AU - Zheng, Xiaotian

AU - Shulman, Stanford T.

AU - Patel, Sameer J.

PY - 2017/6/1

Y1 - 2017/6/1

N2 - Background. Although Clostridium difficile infections (CDIs) are increasingly diagnosed in children, many children diagnosed with CDI lack classic risk factors. Frequent use of highly sensitive tcdB polymerase chain reaction (PCR) testing in low-risk patients leads to CDI misdiagnosis and unnecessary CDI antibiotic use in children with C difficile carriage. Methods. For this quasi-experimental study, we developed and implemented an educational intervention (EI) to inform healthcare providers (HCPs) about tcdB PCR test limitations. We provided HCP didactic education and built an electronic notification into the tcdB PCR test order that describes scenarios in which carriage is more likely than CDI. Segmented regression analysis assessed changes in level (ie, overall rates) and trend of C difficile testing rate ([TR] number of tests performed per 1000 patient encounters) and test positivity rate ([PR] number of positive tests per 1000 patient encounters) between the pre- (August 2009-August 2013) and postintervention (February 2014-July 2015) periods. Results. Hospital-wide, absolute TR reduction was 0.71 (P[level] = .0067; P[trend] = .0042) and absolute PR reduction was 0.14 (P[level] = .22; P[trend] = .018). In the outpatient setting, absolute TR reduction was 0.30 (P[level] = .0015; P[trend] < .001) and absolute PR reduction was 0.09 (P[level] = .0069; P[trend] = .046). The incidence density of healthcare facility-associated CDI did not significantly change after the EI. The EI was associated with avoidance of 574 tests and 113 positive tests (and subsequent antibiotic courses) during the postintervention period, which saved approximately $250 000 in patient charges related to CDI testing and treatment. Conclusions. Healthcare provider education can cost-effectively reduce the frequency of C difficile testing and CDI misdiagnosis by improving test utilization among low-risk children.

AB - Background. Although Clostridium difficile infections (CDIs) are increasingly diagnosed in children, many children diagnosed with CDI lack classic risk factors. Frequent use of highly sensitive tcdB polymerase chain reaction (PCR) testing in low-risk patients leads to CDI misdiagnosis and unnecessary CDI antibiotic use in children with C difficile carriage. Methods. For this quasi-experimental study, we developed and implemented an educational intervention (EI) to inform healthcare providers (HCPs) about tcdB PCR test limitations. We provided HCP didactic education and built an electronic notification into the tcdB PCR test order that describes scenarios in which carriage is more likely than CDI. Segmented regression analysis assessed changes in level (ie, overall rates) and trend of C difficile testing rate ([TR] number of tests performed per 1000 patient encounters) and test positivity rate ([PR] number of positive tests per 1000 patient encounters) between the pre- (August 2009-August 2013) and postintervention (February 2014-July 2015) periods. Results. Hospital-wide, absolute TR reduction was 0.71 (P[level] = .0067; P[trend] = .0042) and absolute PR reduction was 0.14 (P[level] = .22; P[trend] = .018). In the outpatient setting, absolute TR reduction was 0.30 (P[level] = .0015; P[trend] < .001) and absolute PR reduction was 0.09 (P[level] = .0069; P[trend] = .046). The incidence density of healthcare facility-associated CDI did not significantly change after the EI. The EI was associated with avoidance of 574 tests and 113 positive tests (and subsequent antibiotic courses) during the postintervention period, which saved approximately $250 000 in patient charges related to CDI testing and treatment. Conclusions. Healthcare provider education can cost-effectively reduce the frequency of C difficile testing and CDI misdiagnosis by improving test utilization among low-risk children.

KW - Clostridium difficile

KW - Colonization

KW - Microbiology

KW - Pediatric

KW - Testing

UR - http://www.scopus.com/inward/record.url?scp=85014348543&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85014348543&partnerID=8YFLogxK

U2 - 10.1093/jpids/piw027

DO - 10.1093/jpids/piw027

M3 - Article

C2 - 27190172

AN - SCOPUS:85014348543

SN - 2048-7193

VL - 6

SP - 142

EP - 148

JO - Journal of the Pediatric Infectious Diseases Society

JF - Journal of the Pediatric Infectious Diseases Society

IS - 2

M1 - piw027

ER -

Impact of a healthcare provider educational intervention on frequency of clostridium difficile polymerase chain reaction testing in children: A segmented regression analysis

Abstract

Funding

Keywords

ASJC Scopus subject areas

UN SDGs

Access to Document

Other files and links

Fingerprint

Cite this