522 - Health Disparities for Pneumonia and Sinusitis Antibiotic Treatment in the Emergency Department

Publication Number: 2507.522

Joshua A. Saucedo, Children's Mercy Hospitals and Clinics, Kansas City, MO, United States; Leslie A. Hueschen, University of Missouri-Kansas City School of Medicine, Kansas City, MO, United States; Amanda Nedved, Children's Mercy, Lenexa, KS, United States; Rana E. El Feghaly, Children's Mercy Kansas City, UMKC, Kansas City, MO, United States

Background: Optimal antibiotic selection and duration are pillars of antimicrobial stewardship efforts. Previous studies on common acute respiratory infections showed differences in first-line (FL) antibiotic selection when comparing patients' race, ethnicity, language, and insurance status. In our emergency department (ED), >80% of community acquired pneumonia (CAP) and acute bacterial rhinosinusitis (ABRS) are treated with FL guideline-concordant antibiotics (as determined by local and national guidelines), however, differences in care based on socioeconomic factors (race, ethnicity, language, and insurance status) has not been characterized.

Objective: Our aim is to evaluate differences in antibiotic choice and duration in relation to socioeconomic factors, and to analyze changes with quality improvement (QI) efforts.

Design/Methods: A multidisciplinary QI team used multiple Plan-Do-Study-Act cycles and was successful in improving antibiotic duration for CAP and ABRS from a baseline of 13% to 61% (January 2024-July 2025). Here, we evaluate antibiotic choice and duration for these infections in relation to socioeconomic variables and compare the 17-month pre-intervention period (August 2022-December 2023) to the 19-month post-intervention period. We used chi square test to evaluate the data using IBM SPSS software.

Results: Our study included 2943 encounters (Figures 1 and 2). There were no statistically significant differences in the pre-intervention FL antibiotic choice between patients of different races (Black 85.6% vs White 79.5%, p = 0.063), ethnicities (Hispanic 82.8% vs non-Hispanic 81.1%, p = 0.552), and insurances (Medicaid 83.1% vs Private 79.7%, p = 0.211). We saw a disproportionate improvement in FL selection in the post-intervention period with widening of the gap for race (Black 89.5% vs White 79.2%, p < 0.001), ethnicity (Hispanic 88.4% vs non-Hispanic 83.1%, p = 0.004), and insurance (Medicaid 85.3% vs Private 81.2%, p = 0.024) (Table 1). Although we saw substantial improvement in duration post-intervention, there were no statistically significant differences between the different sociodemographic categories in relation to optimal duration in pre- or post-intervention periods.

Conclusion(s): White, non-Hispanic, and patients with private insurance had lower rates of FL therapy and saw less improvement after interventions. Our QI improvement efforts, which focused on improving duration, resulted in similar improvement across socioeconomic groups, with no substantial differences between groups. Further studies to understand and address the underlying factors creating inequities are essential.

Figure 1
Monthly percentage of patients receiving first-line antibiotics by (a) race, (b) ethnicity, (c) insurance, and (d) language in the pre- and post- intervention period. The vertical blue line delineates the start of our quality improvement project.

Figure 2
Figure 2: Monthly percentage of patients receiving optimal antibiotic duration by (a) race, (b) ethnicity, (c) insurance, and (d) language in the pre- and post- intervention period. The vertical blue line delineates the start of our quality improvement project.

Table 1
Demographic categories evaluating first-line antibiotics and optimal duration for Pre- and Post-Intervention periods. Number of patients (n) and percentage of patients (%) included for each category with a p value that reflects the difference between the sociodemographic groups for each study period.