217. Bang for the Buck: Lessons Learned From an Ambulatory Stewardship Pilot to Reduce Excess Antibiotic Prescribing for Adult Upper Respiratory Infections

Background Upper respiratory infections (URIs) are a source of unnecessary antibiotic use in the USA.1 To address antibiotic overuse in our clinics, we participated in a multiphase stewardship collaborative established by the United Hospital Fund. We aimed to pilot stewardship policies for adult URIs at the Montefiore Medical Group (MMG) practices in Bronx, New York. Methods Phase 1: evaluation of provider use of ICD-10 codes for URIs generally not requiring antibiotics at target sites (TS) with random chart abstraction validation. Phase 2: implementation of stewardship interventions (Table 1). Prescribing patterns were evaluated using electronic health record data at the end of Phase 2 comparing TS (n = 6; two resident clinics, four nonresident clinics) to the prior year and to nontarget sites (NTS) (n = 13). Results There were 6,819 visits of interest from October 2017 to February 2018 within MMG. Top three codes utilized are shown in Figure 1. TS prescribing declined postintervention and compared with NTS (Table 2). Nonresident TS participated in four interventions, and resident TS were involved in 2–3. Macrolides were the most utilized antibiotic class (Figure 2). Conclusion We attribute the decline in prescribing at TS to the collective impact of our stewardship activities. Stewardship team driven interventions had better uptake than provider-driven initiatives. We plan to continue activities with the highest uptake and feasibility. Long-term goals include development and integration of stewardship metrics into our outpatient quality structure. Reference 1. Shapiro DJ, Hicks LA, Pavia AT, Hersh AL. Antibiotic prescribing for adults in ambulatory care in the USA, 2007–2009. J Antimicrob Chemother. 2014;69(1):234–40. Table 1: Phase 2 Interventions and Uptake Interventions Intended Clinic Uptake Provider Lectures 5/5 Provider Report Card 6/6 Viral Prescription pad 0/5 Commitment Poster 5/6 Follow-up Phone Calls to Patients 0/2 Educational Email to Patients 4/4 In-office Video Session with Patients 1/1 Waiting Room Video 3/6 Table 2: Prescribing Rates for Top 3 URI ICD-10 Codes Antibiotics Prescribed (%) P-value* TS—October 2017–February 2018 435 (17%) – TS—October 16–February 17 633 (25%) <0.001 NTS—October 17–February 18 736 (25%) <0.001 *Comparing to October 17–February 18 TS; χ2 used. Disclosures All authors: No reported disclosures.