Tracking antibiotic prescribing variation in Arkansas Medicaid patient-centered medical homes

Background and goal: In this study, researchers developed, implemented and measured a claims-based, practice-level performance measure to calculate, track and influence antibiotic prescribing variation across Arkansas Medicaid's patient-centered medical home (PCMH) program. 

Study approach: This retrospective, observational study used 2019–2021 outpatient antibiotic paid claims, attributing each claim to the clinic's patient-centered medical home (PCMH) panel in Arkansas Medicaid. Every practice received a quarterly report card showing its antibiotic rate-paid claims per 1,000 attributed patients per year-and how it compared with other PCMHs. Clinics were labeled high, middle or low prescribers based on 2019 and then tracked through 2020 and 2021. The researchers then compared Arkansas Medicaid rates with Arkansas and U.S. all-payer rates from IQVIA data that CDC publishes every year.

Main results: Out of 216 PCMH sites, 176 were included in the analysis.

• The 2019, 2020, and 2021 cohort prescription rates were 1,089, 785, and 853 per 1,000 attributed patients.

• In 2021, PCMH rates were lower than Arkansas all-payer rates but higher than U.S. all-payer rates.

• The clinics that prescribed the least antibiotics had a rate of 720 prescriptions per 1,000 patients in 2019 and 564 in 2021, while the clinics that prescribed the most had a rate of 1,491 per 1,000 patients in 2019 and 1,140 in 2021.

• Pediatric claims decreased by 25% and adult age groups decreased by 15% in 2021 compared with 2019.

• Rates fell during the years of the COVID pandemic. Without a comparison group, the report cards' specific effect is unknown.

Why it matters: Providing a big picture look of a clinic's prescribing habits may help clinics keep an eye on and reduce unnecessary antibiotic prescriptions as well as identify clinical outliers for data feedback and quality improvement interventions.