Measurement of Practice-Level Antibiotic Utilization in a Medicaid Patient-Centered Medical Home Program.

Abstract

Outpatient antibiotic stewardship needs efficient strategies to remedy pervasive overuse. A claims-based measure of practice-specific antibiotic utilization in a Medicaid patient-centered medical home (PCMH) program was developed, implemented, and measured. This observational study analyzed outpatient antibiotic paid claims attributed to PCMH panels during 2019, 2020, and 2021. Practices received quarterly antibiotic prescribing rate report cards, as paid claims per 1,000 patients per year which included specific performance in comparison to other PCMHs. We identified high-, middle-, and low-utilization sites at baseline and then tracked prescribing during the observation period. Arkansas Medicaid data were compared with all-payer state and national data measured by the IQVIA and published annually by the Centers for Disease Control and Prevention. In 2019, 176 of 216 PCMH sites met inclusion criteria. Cohort prescription rates were 1,089 in 2019, 785 in 2020, and 853 in 2021. Arkansas IQVIA all-payer rates for years 2019, 2020, and 2021 were 1,028, 844, and 927, while national IQVIA rates were lower at 765, 613, and 636, respectively. The Arkansas PCMH practice prescription rates in 2019 ranged from 720 to 1,491. By 2021, the range was 564 to 1,140. PCMH data showed reduced antibiotic prescribing in 2021 vs 2019 compared with national and state-specific IQVIA all-payer data analysis. Analysis of antibiotic prescriptions per 1,000 patients at the practice level is feasible. Regular report cards to PCMHs were associated with reduced prescribing rates in 2021 relative to IQVIA national and state data.