Table 2. Usage Trends in Guideline Nonrecommended Tests and Treatments.
| Service | Guideline period 1 (2006-2014) | Guideline period 2 (2014-2019) | Change between guideline periods | |||||
|---|---|---|---|---|---|---|---|---|
| Adjusted use, % (95% CI) | Monthly slope (95% CI) | Adjusted use, % (95% CI) | Monthly slope (95% CI) | Change in slope (95% CI)a | Level change (95% CI)b | |||
| Start | End | Start | End | |||||
| Testing | ||||||||
| ED group | ||||||||
| Complete blood count | 6.4 (5.1-7.7) | 3.7 (2.4-5.0) | −0.03 (−0.04 to −0.02) | 4.0 (2.7-5.3) | 2.3 (1.0-3.6) | −0.02 (−0.03 to −0.003) | 0.01 (−0.01 to 0.027) | 0.3 (−0.3 to 1.0) |
| Chest radiograph | 48.4 (44.0-52.9) | 30.2 (25.9-34.5) | −0.19 (−0.21 to −0.18) | 25.9 (21.5-30.2) | 14.2 (9.8-18.7) | −0.13 (−0.17 to −0.09) | 0.06 (0.02 to 0.10) | −4.1 (−5.9 to −2.4) |
| Viral testing | 23.5 (16.2-30.8) | 22.6 (15.3-29.8) | −0.01 (−0.04 to 0.01) | 18.9 (11.6-26.1) | 18.3 (11.0-25.6) | −0.04 (−0.09 to −0.01) | −0.03 (−0.08 to 0.03) | −3.7 (−5.9 to −1.5) |
| Inpatient group | ||||||||
| Complete blood count | 44.6 (39.8-49.3) | 32.2 (27.6-36.8) | −0.13 (−0.16 to −0.11) | 31.5 (26.8-36.1) | 23.6 (18.8-28.3) | −0.07 (−0.12 to −0.03) | 0.07 (0.02 to 0.11) | −0.8 (−2.7 to 1.1) |
| Chest radiograph | 78.8 (75.6-82.1) | 57.3 (54.2-60.4) | −0.23 (−0.26 to −0.21) | 51.1 (47.9-54.2) | 37.3 (34.0-40.6) | −0.23 (−0.27 to −0.19) | 0.01 (−0.04 to 0.06) | −6.3 (−8.1 to −4.4) |
| Viral testing | 60.9 (55.3-66.6) | 48.7 (43.1-54.2) | −0.13 (−0.16 to −0.11) | 41.4 (35.8-46.9) | 33.5 (27.8-39.2) | −0.11 (−0.16 to −0.05) | 0.03 (−0.03 to 0.09) | −7.3 (−9.6 to −5.0) |
| Treatment | ||||||||
| ED group | ||||||||
| Bronchodilators | 56.3 (51.1-61.5) | 46.1 (41.0-51.2) | −0.11 (−0.13 to −0.09) | 32.5 (27.3-37.7) | 26.0 (20.8-31.2) | −0.26 (−0.30 to −0.23) | −0.15 (−0.20 to −0.11) | −13.5 (−15.2 to −11.8) |
| Steroids | 15.7 (13.0-18.3) | 11.1 (8.5-13.7) | −0.05 (−0.06 to −0.04) | 9.0 (6.4-11.6) | 6.1 (3.4-8.7) | −0.04 (−0.06 to −0.01) | 0.01 (−0.02 to 0.04) | −2.0 (−3.1 to −0.9) |
| Antibiotics | 4.2 (3.3-5.0) | 3.6 (2.7-4.4) | −0.01 (−0.01 to −0.001) | 3.1 (2.2-3.9) | 2.7 (1.8-3.6) | 0.01 (−0.004 to 0.02) | 0.01 (0.001 to 0.03) | −0.5 (−1.0 to −0.01) |
| Inpatient group | ||||||||
| Bronchodilators | 73.0 (68.0-78.0) | 65.8 (60.9-70.7) | −0.08 (−0.10 to −0.05) | 54.7 (49.8-59.6) | 50.1 (45.1-55.1) | −0.26 (−0.30 to −0.22) | −0.18 (−0.23 to −0.13) | −11.3 (−13.1 to −9.4) |
| Steroids | 38.6 (35.3-42.0) | 29.8 (26.7-32.9) | −0.09 (−0.12 to −0.07) | 23.6 (20.5-26.7) | 17.9 (14.6-21.2) | −0.08 (−0.13 to −0.03) | 0.01 (−0.04 to 0.07) | −6.2 (−8.5 to −3.9) |
| Antibiotics | 49.1 (46.9-51.2) | 34.0 (32.2-35.9) | −0.16 (−0.19 to −0.14) | 33.4 (31.5-35.2) | 23.8 (21.6-25.9) | −0.11 (−0.15 to −0.07) | 0.06 (0.01 to 0.11) | −0.7 (−2.7 to 1.3) |
| Balancing | ||||||||
| Hospital admission rate | 18.0 (13.8-22.2) | 18.0 (13.8-22.2) | 0.00 (−0.004 to 0.004) | 17.9 (13.6-22.1) | 17.8 (13.6-22.1) | 0.02 (0.01 to 0.03) | 0.02 (0.01 to 0.03) | −0.02 (−0.01 to 0.03) |
| Length of stay, d | 2.0 (1.9-2.1) | 1.8 (1.7-1.9) | −0.002 (−0.003 to −0.001) | 1.9 (1.8-1.9) | 1.7 (1.7-1.8) | −0.002 (−0.003 to 0.000) | 0.001 (0 to 0.002) | 0.03 (0.02 to 0.08) |
Abbreviation: ED, emergency department.
a
Change in slope is defined as the difference in slope between guideline period 1 and guideline period 2.
b
Level change is defined as the change in usage rate between the 2 time periods (ie, start of guideline period 2 vs end of guideline period 1) using 2014 guideline publication as the event point.