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

项目概要/摘要 在美国，牙科医生负责大约10%的门诊抗生素处方。许多 这些抗生素处方是不必要的，并使患者面临药物不良事件的风险，包括 过敏反应和耐药微生物感染。然而，改善抗生素处方 牙科环境中的实践具有挑战性。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 实践 我的长期目标是监督电子临床决策支持工具（CDST）的开发， 促进牙医之间的最佳抗生素处方。我设想创造，试点测试，和传播 CDST可嵌入电子健康记录系统，包括电子牙科记录 系统，以提高对基于科学的实践的坚持，同时使临床医生的生活更轻松。 这个具体的建议旨在设计和实现一个新的基于Web的应用程序“应用程序”，可以 由牙医在移动的电话或网站上访问。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牙科学生、住院医生和教师的反馈（UIC- COD）。我们的第二个目标是使用临床插图和经过验证的技术调查对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 CDST实施前后的抗生素知识和抗生素决策信心 使用配对调查。我们还将使用调查来衡量供应商对CDST的满意度。我们将跟踪 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 我们的CDST在社区牙医通过国家牙科和颅面研究所牙科实践 基于研究网络，并申请拨款资助，将此CDST嵌入电子牙科记录 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.