Difference-in-Differences Estimates of Change in Antibiotic Initiation, Duration and Clinical Outcomes According to Whether Long-Term Care Residents Were Cared for by Physicians Enrolled or Not Enrolled in Audit and Feedback
| Outcome . | Pre- or Post-intervention . | Not enrolled . | Enrolled . | Model Typea . | DID% (95% CI) . | Pr > |Z| . |
|---|---|---|---|---|---|---|
| Initiation of antibiotic, no. (%) | Pre | 48 427 (25.9%) | 28 712 (25.0%) | Unadjusted | .08% (−.55%, .67%) | 0.788 |
| Post | 42 939 (22.8%) | 25 090 (21.9%) | Adjusted | .10% (−.51%, .67%) | 0.735 | |
| Duration of antibiotic >7 days, no. (%) | Pre | 18 252 (34.8%) | 9972 (33.0%) | Unadjusted | −2.70% (−4.98%, −.22%) | 0.025 |
| Post | 14 193 (31.9%) | 7001 (27.6%) | Adjusted | −2.65% (−4.93%, −.28%) | 0.026 | |
| Antibiotic-related ED visit, no. (%) | Pre | 779 (0.4%) | 458 (0.4%) | Unadjusted | −.03% (−.10%, .03%) | 0.364 |
| Post | 756 (0.4%) | 405 (0.4%) | Adjusted | −.03% (−.10%, .03%) | 0.338 | |
| Infection-related ED visit, no. (%) | Pre | 9294 (5.0%) | 5252 (4.6%) | Unadjusted | .23% (−.01%, .47%) | 0.074 |
| Post | 8751 (4.6%) | 5105 (4.5%) | Adjusted | .22% (−.00%, .46%) | 0.067 | |
| All-cause ED visit, no. (%) | Pre | 25 724 (13.8%) | 15 129 (13.2%) | Unadjusted | .12% (−.30%, .53%) | 0.597 |
| Post | 24 996 (13.2%) | 14 583 (12.8%) | Adjusted | .14% (−.25%, .55%) | 0.498 | |
| All-cause hospitalization, no. (%) | Pre | 12 918 (6.9%) | 7742 (6.7%) | Unadjusted | .14% (−.16%, .47%) | 0.382 |
| Post | 12 533 (6.6%) | 7547 (6.6%) | Adjusted | .17% (−.13%, .48%) | 0.270 | |
| All-cause death, no. (%) | Pre | 268 (0.1%) | 162 (0.1%) | Unadjusted | −.01% (−.05%, .03%) | 0.650 |
| Post | 280 (0.2%) | 156 (0.1%) | Adjusted | −.01% (−.05%, .03%) | . | |
| Initiation of benzodiazepine or antipsychotic medication, no. (%) | Pre | 64 665 (34.6%) | 37 626 (32.7%) | Unadjusted | .09% (−.49%, .67%) | 0.764 |
| Post | 64 705 (34.3%) | 37 126 (32.5%) | Adjusted | .17% (−.41%, .73%) | 0.579 |
| Outcome . | Pre- or Post-intervention . | Not enrolled . | Enrolled . | Model Typea . | DID% (95% CI) . | Pr > |Z| . |
|---|---|---|---|---|---|---|
| Initiation of antibiotic, no. (%) | Pre | 48 427 (25.9%) | 28 712 (25.0%) | Unadjusted | .08% (−.55%, .67%) | 0.788 |
| Post | 42 939 (22.8%) | 25 090 (21.9%) | Adjusted | .10% (−.51%, .67%) | 0.735 | |
| Duration of antibiotic >7 days, no. (%) | Pre | 18 252 (34.8%) | 9972 (33.0%) | Unadjusted | −2.70% (−4.98%, −.22%) | 0.025 |
| Post | 14 193 (31.9%) | 7001 (27.6%) | Adjusted | −2.65% (−4.93%, −.28%) | 0.026 | |
| Antibiotic-related ED visit, no. (%) | Pre | 779 (0.4%) | 458 (0.4%) | Unadjusted | −.03% (−.10%, .03%) | 0.364 |
| Post | 756 (0.4%) | 405 (0.4%) | Adjusted | −.03% (−.10%, .03%) | 0.338 | |
| Infection-related ED visit, no. (%) | Pre | 9294 (5.0%) | 5252 (4.6%) | Unadjusted | .23% (−.01%, .47%) | 0.074 |
| Post | 8751 (4.6%) | 5105 (4.5%) | Adjusted | .22% (−.00%, .46%) | 0.067 | |
| All-cause ED visit, no. (%) | Pre | 25 724 (13.8%) | 15 129 (13.2%) | Unadjusted | .12% (−.30%, .53%) | 0.597 |
| Post | 24 996 (13.2%) | 14 583 (12.8%) | Adjusted | .14% (−.25%, .55%) | 0.498 | |
| All-cause hospitalization, no. (%) | Pre | 12 918 (6.9%) | 7742 (6.7%) | Unadjusted | .14% (−.16%, .47%) | 0.382 |
| Post | 12 533 (6.6%) | 7547 (6.6%) | Adjusted | .17% (−.13%, .48%) | 0.270 | |
| All-cause death, no. (%) | Pre | 268 (0.1%) | 162 (0.1%) | Unadjusted | −.01% (−.05%, .03%) | 0.650 |
| Post | 280 (0.2%) | 156 (0.1%) | Adjusted | −.01% (−.05%, .03%) | . | |
| Initiation of benzodiazepine or antipsychotic medication, no. (%) | Pre | 64 665 (34.6%) | 37 626 (32.7%) | Unadjusted | .09% (−.49%, .67%) | 0.764 |
| Post | 64 705 (34.3%) | 37 126 (32.5%) | Adjusted | .17% (−.41%, .73%) | 0.579 |
Abbreviations: CI, confidence interval; DID, difference-in-differences; ED, emergency department.
a Adjusted models were accounted for clustering, temporal trends and resident age, sex, 14 comorbidities (diabetes, congestive heart failure, hypertension, arteriosclerotic heart disease, stroke, peripheral vascular disease, dementia, cancer, chronic obstructive pulmonary disease, Parkinson’s disease, gastrointestinal disease, liver disease, renal failure), degree of functional dependence for each activity of daily, bowel/bladder incontinence, hearing/visual impairment, and device use (urinary catheter, dialysis, intravenous medications, tracheostomy, ventilator, feeding tube).
Difference-in-Differences Estimates of Change in Antibiotic Initiation, Duration and Clinical Outcomes According to Whether Long-Term Care Residents Were Cared for by Physicians Enrolled or Not Enrolled in Audit and Feedback
| Outcome . | Pre- or Post-intervention . | Not enrolled . | Enrolled . | Model Typea . | DID% (95% CI) . | Pr > |Z| . |
|---|---|---|---|---|---|---|
| Initiation of antibiotic, no. (%) | Pre | 48 427 (25.9%) | 28 712 (25.0%) | Unadjusted | .08% (−.55%, .67%) | 0.788 |
| Post | 42 939 (22.8%) | 25 090 (21.9%) | Adjusted | .10% (−.51%, .67%) | 0.735 | |
| Duration of antibiotic >7 days, no. (%) | Pre | 18 252 (34.8%) | 9972 (33.0%) | Unadjusted | −2.70% (−4.98%, −.22%) | 0.025 |
| Post | 14 193 (31.9%) | 7001 (27.6%) | Adjusted | −2.65% (−4.93%, −.28%) | 0.026 | |
| Antibiotic-related ED visit, no. (%) | Pre | 779 (0.4%) | 458 (0.4%) | Unadjusted | −.03% (−.10%, .03%) | 0.364 |
| Post | 756 (0.4%) | 405 (0.4%) | Adjusted | −.03% (−.10%, .03%) | 0.338 | |
| Infection-related ED visit, no. (%) | Pre | 9294 (5.0%) | 5252 (4.6%) | Unadjusted | .23% (−.01%, .47%) | 0.074 |
| Post | 8751 (4.6%) | 5105 (4.5%) | Adjusted | .22% (−.00%, .46%) | 0.067 | |
| All-cause ED visit, no. (%) | Pre | 25 724 (13.8%) | 15 129 (13.2%) | Unadjusted | .12% (−.30%, .53%) | 0.597 |
| Post | 24 996 (13.2%) | 14 583 (12.8%) | Adjusted | .14% (−.25%, .55%) | 0.498 | |
| All-cause hospitalization, no. (%) | Pre | 12 918 (6.9%) | 7742 (6.7%) | Unadjusted | .14% (−.16%, .47%) | 0.382 |
| Post | 12 533 (6.6%) | 7547 (6.6%) | Adjusted | .17% (−.13%, .48%) | 0.270 | |
| All-cause death, no. (%) | Pre | 268 (0.1%) | 162 (0.1%) | Unadjusted | −.01% (−.05%, .03%) | 0.650 |
| Post | 280 (0.2%) | 156 (0.1%) | Adjusted | −.01% (−.05%, .03%) | . | |
| Initiation of benzodiazepine or antipsychotic medication, no. (%) | Pre | 64 665 (34.6%) | 37 626 (32.7%) | Unadjusted | .09% (−.49%, .67%) | 0.764 |
| Post | 64 705 (34.3%) | 37 126 (32.5%) | Adjusted | .17% (−.41%, .73%) | 0.579 |
| Outcome . | Pre- or Post-intervention . | Not enrolled . | Enrolled . | Model Typea . | DID% (95% CI) . | Pr > |Z| . |
|---|---|---|---|---|---|---|
| Initiation of antibiotic, no. (%) | Pre | 48 427 (25.9%) | 28 712 (25.0%) | Unadjusted | .08% (−.55%, .67%) | 0.788 |
| Post | 42 939 (22.8%) | 25 090 (21.9%) | Adjusted | .10% (−.51%, .67%) | 0.735 | |
| Duration of antibiotic >7 days, no. (%) | Pre | 18 252 (34.8%) | 9972 (33.0%) | Unadjusted | −2.70% (−4.98%, −.22%) | 0.025 |
| Post | 14 193 (31.9%) | 7001 (27.6%) | Adjusted | −2.65% (−4.93%, −.28%) | 0.026 | |
| Antibiotic-related ED visit, no. (%) | Pre | 779 (0.4%) | 458 (0.4%) | Unadjusted | −.03% (−.10%, .03%) | 0.364 |
| Post | 756 (0.4%) | 405 (0.4%) | Adjusted | −.03% (−.10%, .03%) | 0.338 | |
| Infection-related ED visit, no. (%) | Pre | 9294 (5.0%) | 5252 (4.6%) | Unadjusted | .23% (−.01%, .47%) | 0.074 |
| Post | 8751 (4.6%) | 5105 (4.5%) | Adjusted | .22% (−.00%, .46%) | 0.067 | |
| All-cause ED visit, no. (%) | Pre | 25 724 (13.8%) | 15 129 (13.2%) | Unadjusted | .12% (−.30%, .53%) | 0.597 |
| Post | 24 996 (13.2%) | 14 583 (12.8%) | Adjusted | .14% (−.25%, .55%) | 0.498 | |
| All-cause hospitalization, no. (%) | Pre | 12 918 (6.9%) | 7742 (6.7%) | Unadjusted | .14% (−.16%, .47%) | 0.382 |
| Post | 12 533 (6.6%) | 7547 (6.6%) | Adjusted | .17% (−.13%, .48%) | 0.270 | |
| All-cause death, no. (%) | Pre | 268 (0.1%) | 162 (0.1%) | Unadjusted | −.01% (−.05%, .03%) | 0.650 |
| Post | 280 (0.2%) | 156 (0.1%) | Adjusted | −.01% (−.05%, .03%) | . | |
| Initiation of benzodiazepine or antipsychotic medication, no. (%) | Pre | 64 665 (34.6%) | 37 626 (32.7%) | Unadjusted | .09% (−.49%, .67%) | 0.764 |
| Post | 64 705 (34.3%) | 37 126 (32.5%) | Adjusted | .17% (−.41%, .73%) | 0.579 |
Abbreviations: CI, confidence interval; DID, difference-in-differences; ED, emergency department.
a Adjusted models were accounted for clustering, temporal trends and resident age, sex, 14 comorbidities (diabetes, congestive heart failure, hypertension, arteriosclerotic heart disease, stroke, peripheral vascular disease, dementia, cancer, chronic obstructive pulmonary disease, Parkinson’s disease, gastrointestinal disease, liver disease, renal failure), degree of functional dependence for each activity of daily, bowel/bladder incontinence, hearing/visual impairment, and device use (urinary catheter, dialysis, intravenous medications, tracheostomy, ventilator, feeding tube).
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