Instructions for Antibiotic Prescription Data Template_Antibiotic Stewardship Cohort

Form Approved
OMB No. 0935-XXXX
Exp. Date XX/XX/20XX

Attachment L: Instructions for Antibiotic Prescription Data

Template—Antibiotic Stewardship Cohort

Instructions for Template Used to Extract Antibiotic Prescribing Data from the EHR

Antibiotic Stewardship Cohort

We are requesting that your practice submit two key types of data related to antibiotic prescribing (see details below). This data will be an important way for your practice to monitor its prescribing practices throughout the course of the program and will be used by the assessment team to monitor and describe prescribing trends across practices enrolled in the program. Thank you for taking the time to submit your data.

Antibiotic prescribing data will include:

• Total antibiotic prescriptions per 100 telemedicine visits: Antibiotic prescriptions are defined as any separate prescription electronically transmitted to a pharmacy for a patient associated with a telemedicine visit, either videoconferencing or over the phone. Each antibiotic prescription is counted independently, even if more than one antibiotic was prescribed in a visit. Additional antibiotic prescriptions overall (that is, both associated with a visit and not associated with a visit) will be requested. Antibiotic drug class will also be collected. Telemedicine visits are defined as the number of telemedicine visits made by a patient to that practice over videoconference or telephone-based telemedicine. This is a monthly collected measure from June 2024 to November 2025 and will be requested quarterly.

• Antibiotic prescriptions per 100 antibiotic-inappropriate acute respiratory tract infection telemedicine visits: Antibiotic prescriptions are defined as any separate prescription electronically transmitted to a pharmacy for a patient associated with a telemedicine visit for an antibiotic-inappropriate acute respiratory tract infection. Each antibiotic prescription is counted independently, even if more than one antibiotic was prescribed in a visit. Antibiotic drug class will also be collected. Denominator is total number of patients with a telemedicine visit (including videoconferencing or telephone-based visit) associated with an ICD-10 code for a non-antibiotic-appropriate respiratory condition. This is a monthly collected measure from June 2024 to November 2025 and will be requested quarterly.

Public reporting burden for this collection of information is estimated to average 1 hour per response, the estimated time required to complete the monthly data collection using the data collection template. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number.  Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: AHRQ Reports Clearance Officer Attention: PRA, Paperwork Reduction Project (0935-XXXX) AHRQ, 540 Gaither Road, Room # 5036, Rockville, MD 20850.