Using Implementation Science and Informatics to Develop and Pilot Test Antibiotic Stewardship Clinical Decision Support

项目摘要/摘要 在美国，大约10%的门诊抗生素处方由牙医负责。许多 这些抗生素的处方是不必要的，并将患者置于不良药物事件的风险中，包括 过敏反应和耐药生物体感染。然而，改善抗生素处方 在牙科环境中的实践是具有挑战性的。牙科诊所往往缺乏资源来设计和实施 评估牙科抗生素处方实践和设计干预措施以改善处方的政策 练习。 我的长期目标是监督电子临床决策支持工具(CDST)的发展，以 在牙医中促进抗生素的最佳处方。我设想创建、试点测试和传播 可嵌入电子健康记录系统的CDST，包括电子牙科记录 系统，以提高对以科学为基础的做法的遵守，同时使临床医生的生活更容易。 这一具体提案旨在设计和实现一种新型的基于Web的应用程序“app”，该应用程序可以 由牙医通过手机或网站访问。我们的第一个目标是设计基于焦点小组的CDST 来自伊利诺伊大学牙科学院(UIC-)牙科学生、住院医生和教职员工的反馈 鳕鱼)。我们的第二个目标是使用临床小插曲和经过验证的技术调查对该应用程序进行试点测试 问题。第三个目标是评估我们的CDST在UIC-COD中的有效性和实施情况 使用传播和实施研究框架。我们将建议衡量以下变化 CDST实施前后抗生素知识及对抗生素决策的信心 使用配对调查。我们还将使用调查来衡量提供商对CDST的满意度。我们会追踪 使用Google Analytics的CDST使用率(实施指标)。在这个项目完成后，我们计划测试 我们通过国家牙科和颅面研究牙科实践研究所在社区牙医中的CDST 基于研究网络并申请拨款将此CDST嵌入到电子牙科记录中 系统。

Project Summary/Abstract Dentists are responsible for approximately 10% of outpatient antibiotic prescriptions in the United States. Many of these antibiotic prescriptions are unnecessary and place patients at risk of adverse drug events, including allergic reactions and infections with drug resistant organisms. However, improving antibiotic prescribing practices in dental settings is challenging. Dental clinics often lack the resources to design and implement policies to evaluate dental antibiotic prescribing practices and design interventions to improve prescribing practices. My long-term goal is to oversee the development of electronic clinical decision support tools (CDST) to facilitate optimal antibiotic prescribing among dentists. I envision creating, pilot testing, and disseminating CDSTs that can be embedded within electronic health record systems, including electronic dental record systems, to improve adherence to science-based practices while making the lives of clinicians easier. This specific proposal aims to design and implement a novel web-based application “app” that can be accessed by dentists on mobile phones or websites. Our first aim is to design the CDST based on focus group feedback from dental students, residents, and faculty at the University of Illinois College of Dentistry (UIC- COD). Our second aim is to pilot test the app using clinical vignettes and validated technology survey questions. The third aim is to evaluate the effectiveness and implementation of our CDST within UIC-COD using a dissemination and implementation research framework. We will propose to measure changes in antibiotic knowledge and confidence in antibiotic decision making before and after implementation of the CDST using paired surveys. We will also use surveys to measure provider satisfaction with the CDST. We will track CDST usage (implementation metrics) using Google analytics. After completion of this project, we plan to test our CDST in community dentists via the National Institute for Dental and Craniofacial Research Dental Practice Based Research Network and apply for grant funding to embed this CDST into electronic dental record systems.