Off-target impact of clinician feedback reports on antibiotic use in children with medical complexity hospitalized with community-acquired pneumonia.

In prior work, we demonstrated that clinician audit and feedback reports summarizing adherence to appropriate antibiotic choice and duration metrics in previously healthy children with non-severe community-acquired pneumonia (CAP) were associated with improved antibiotic use in this population. In this exploratory study, we evaluated the off-target impact of these reports on antibiotic choice and duration in a small cohort of medically complex children cared for concurrently by these same clinicians. The feedback report-based intervention was also associated with an increase in adherence to the appropriate antibiotic choice and duration metrics among the medically complex children, despite these children being excluded from the reports. These preliminary, hypothesis generating findings provide proof-of-principle that the impact of clinician feedback reports is broader than the population specifically included in the report, and should inform future studies evaluating the safety and effectiveness of feedback-report based interventions.