title: Roles of Clinician, Patient, and Community Characteristics in the Management of Pediatric Upper Respiratory Tract Infections.
abstract: OBJECTIVE
  Prior studies have evaluated factors predictive of inappropriate antibiotic prescription for upper respiratory tract infections (URIs). Community factors, however, have not been examined. The aim of this study was to evaluate the roles of patient, clinician, and community factors in predicting appropriate management of URIs in children.
  
  
  METHODS
  We used a novel database exchange, linking electronic health record data with community statistics, to identify all patients aged 3 months to 18 years in whom URI was diagnosed in the period from 2007 to 2012. We followed the Healthcare Effectiveness Data and Information Set (HEDIS) quality measurement titled "Appropriate treatment for children with upper respiratory infection" to determine the rate of appropriate management of URIs. We then stratified data across individual and community characteristics and used multiple logistic regression modeling to identify variables that independently predicted antibiotic prescription.
  
  
  RESULTS
  Of 20,581 patients, the overall rate for appropriate management for URI was 93.5%. Family medicine clinicians (AOR = 1.5; 95% CI 1.31, 1.71; reference = pediatric clinicians), urgent care clinicians (AOR = 2.23; 95% CI 1.93, 2.57; reference = pediatric clinicians), patients aged 12 to 18 years (AOR = 1.44; 95% CI 1.25, 1.67; reference = age 3 months to 4 years), and patients of white race/ ethnicity (AOR = 1.83; 95% CI 1.41, 2.37; reference = black non-Hispanic) were independently predictive of antibiotic prescription. No community factors were independently predictive of antibiotic prescription.
  
  
  CONCLUSIONS
  Results correlate with prior studies in which non-pediatric clinicians and white race/ethnicity were predictive of antibiotic prescription, while association with older patient age has not been previously reported. Findings illustrate the promise of linking electronic health records with community data to evaluate health care disparities.
authors.affiliation: St. Christopher's Hospital for Children, Drexel University College of Medicine, Department of Pediatrics, Philadelphia, Pennsylvania jeffrey.yaeger@drexelmed.edu.
authors.forename: Jeffrey P
authors.initials: JP
authors.lastname: Yaeger
authors.affiliation: University of Wisconsin School of Medicine and Public Health, Department of Family Medicine, Madison, Wisconsin.
authors.forename: Jonathan L
authors.initials: JL
authors.lastname: Temte
authors.affiliation: University of Wisconsin School of Medicine and Public Health, Department of Family Medicine, Madison, Wisconsin.
authors.forename: Lawrence P
authors.initials: LP
authors.lastname: Hanrahan
authors.affiliation: Drexel University Dornsife School of Public Health, Department of Community Health and Prevention, Philadelphia, Pennsylvania.
authors.forename: P
authors.initials: P
authors.lastname: Martinez-Donate
mesh_terms: D000293:Adolescent; D000367:Age Factors; D000553:Ambulatory Care / Q000706:statistics & numerical data; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D057286:Electronic Health Records; D005194:Family Practice / Q000706:statistics & numerical data; D005260:Female; D054625:Healthcare Disparities / Q000706:statistics & numerical data; D006801:Humans; D057970:Inappropriate Prescribing / Q000706:statistics & numerical data; D007223:Infant; D016015:Logistic Models; D008297:Male; D010372:Pediatrics / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011787:Quality of Health Care / Q000706:statistics & numerical data*; D012111:Residence Characteristics / Q000706:statistics & numerical data*; D012141:Respiratory Tract Infections / Q000188:drug therapy*; D044465:White People / Q000706:statistics & numerical data
chemical_list: D000900:Anti-Bacterial Agents
keywords: adolescents; children; electronic health records; health care delivery; health services research; infants; informatics; information management; public health; social conditions