Figure 1

conceptual model for treatment of asymptomatic bacteriuria (ABU) and patient health outcomes. Our conceptual model adapts and updates elements of the Cabana model of "Why don't physicians follow clinical practice guidelines?" to focus on the following barriers to guideline implementation: awareness and familiarity (knowledge), agreement and outcome expectancy (attitudes), and external barriers (behavior). The audit-feedback intervention will tackle 2 points in the chain of events that leads from a patient at risk to a patient who receives unnecessary antibiotics for ABU: the decision to order a urine culture (inappropriate screening) and the decision to treat a positive urine culture (inappropriate prescribing). We can measure the clinical outcomes after each of these points (objective 1), and at the same time we can measure changes in providers' awareness, familiarity, acceptance, and outcomes expectancy of ABU guidelines (objective 2). This conceptual model will help us determine which aspects of our implementation protocol are responsible for the observed changes in clinical outcomes.