ORIGINAL RESEARCH
Matthew F. Daley, MD; Liza M. Reifler, MPH; Andrew T. Sterrett, PhD; Andrew J. Maclennan, MD; D. Brian Winn, MD; P. Michael Ho, MD, PhD; John F. Steiner, MD, MPH; Sharisse M. Arnold Rehring, MD
Corresponding Author: Matthew F. Daley, MD; Institute for Health Research, Kaiser Permanente Colorado; Department of Pediatrics, University of Colorado School of Medicine.
Email: matthew.f.daley@kp.org
DOI: 10.3122/jabfm.2026.260123R1
Keywords: Antibiotics, Clinical Decision Support, Duration of Therapy, Electronic Health Records, Implementation Science, Infectious Diseases, Otitis Media, Outcomes Research, Pediatrics, RE-AIM Framework
Dates: Submitted: 3/30/2026; Revised: 8/18/2026; Accepted: 8/31/2026
Status: In Press.
PURPOSE: Acute otitis media (AOM), common during childhood, is frequently treated with a 10 day antibiotic course, despite national guidelines for shorter duration. We implemented a multi component intervention to reduce antibiotic duration from 10 to 5 days among children aged 2-17 years.
METHODS: The study was conducted at a large integrated healthcare organization. The intervention included an interactive educational session and clinical decision support, including an AOM order set recommending a 5-day antibiotic duration. The intervention was implemented on 9/23/2020. Interrupted time series analyses assessed antibiotic duration before and after the intervention, within a study period of 1/1/2016 through 3/31/2023. Electronic health record data were used to identify AOM diagnoses, antibiotic duration, and prescribing clinician. We used the RE-AIM implementation framework to assess the intervention.
RESULTS: During the study period, 22,969 children had 30,728 episodes of AOM (reach). In analyses adjusted for clustering of AOM episodes within children and clinicians, 6.1% received a 5-day antibiotic course pre-intervention vs. 65.1% post-intervention, p<0.001 (effectiveness). Overall, 224 clinicians prescribed antibiotics for ≥1 AOM episode before and after the intervention, of whom 157 (70.1%) attended the educational session (adoption). Using the AOM order set to prescribe antibiotics increased from 28.9% pre-intervention to 67.3% post intervention, p<0.001 (implementation). In mediation analysis, an estimated 66% of prescribing behavior change was mediated through AOM order set use (implementation). Intervention effectiveness was sustained for >2 years after the intervention (maintenance).
CONCLUSIONS: A multi-component intervention was associated with sustained changes in clinicians’ prescribing behaviors for the treatment of AOM in children.