Implementing a Discharge Stewardship Bundle to improve antibiotic use at transition from hospital to home

实施出院管理捆绑包以改善从医院到家庭过渡期间抗生素的使用

• 批准号: 10457849
• 负责人: Jeffrey Stephen Gerber
• 金额: $ 48.17万
• 依托单位: CHILDREN'S HOSP OF PHILADELPHIA
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-08-01 至 2025-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10457849
• 关键词: Implementing; Discharge; Stewardship; Bundle; improve

Project Summary / Abstract Pediatric antibiotic stewardship programs (ASPs) in hospital and outpatient settings optimize the use of antibiotics to improve clinical outcomes, decrease adverse drug events, and reduce the emergence of antibiotic resistant bacteria. However, stewardship for patients at the transition from hospital discharge to home, or “discharge stewardship,” is an unmet need for several reasons. First, few pediatric stewardship programs perform discharge stewardship. Second, approximately 30% of pediatric patients receive antibiotics at hospital discharge. Third, the majority of antibiotic days prescribed for hospitalized patients occur after discharge. Fourth, up to half of discharge antibiotic prescriptions are suboptimal, which includes choosing the wrong drug, dose, route, or duration of therapy. This project will use an implementation science framework to develop, implement, and test the effectiveness of a multifaceted discharge stewardship intervention for hospitalized children with the three most common indications for antibiotic prescribing in hospitalized children - community-acquired pneumonia (CAP), urinary tract infections (UTI), and skin/soft tissue infections (SSTI) - at four children's hospitals to establish a foundation for future expansion to additional target populations. Antibiotic choice, dose, route, and duration of therapy will be addressed. Aim 1 is to develop, locally adapt, and implement a discharge stewardship intervention across the four participating sites. The integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework will guide a rapid formative evaluation to identify contextual factors likely to facilitate or hinder the implementation of a discharge stewardship intervention at each site. Based on these results, local facilitators will work to develop and implement a discharge stewardship intervention comprised of consensus driven clinical prescribing guidelines for CAP, UTI, and SSTI plus quarterly feedback of prescribing data based on these guidelines. Aim 2 is to measure the impact of the discharge stewardship intervention on antibiotic prescribing (the primary outcome) and patient-centered balancing measures. For the primary outcome, suboptimal antibiotic prescribing, we will use retrospective data collection leveraging validated diagnostic code-based algorithms to maximize consistency and feasibility for future dissemination. For the balancing metrics, treatment failure and post- discharge adverse drug events, we will use prospective data collection from parents of patients with CAP, UTI, and SSTI to maximize their capture. Both sub-aims will utilize a time series analysis based on 18 months of pre-intervention data followed by 30 months of post-intervention data. This project will form the foundation for future dissemination of discharge stewardship to a broader array of patient populations. Investigators on this proposal form the leadership of the Sharing Antimicrobial Reports for Pediatric Stewardship (SHARPS) Collaborative, a network comprised of more than 60 children's hospitals across North America that is uniquely positioned to adopt antimicrobial stewardship interventions designed to target prescribing at hospital discharge.

项目概要/摘要 医院和门诊环境中的儿科抗生素管理计划 (ASP) 优化了抗生素的使用 抗生素可改善临床结果、减少药物不良事件并减少 抗生素耐药细菌。然而，患者从出院到出院过渡期间的管理 由于多种原因，家庭或“出院管理”的需求尚未得到满足。首先，儿科管理工作很少 程序执行出院管理。其次，大约 30% 的儿科患者接受抗生素治疗 出院时。第三，大多数为住院患者开具抗生素的天数发生在 释放。第四，多达一半的出院抗生素处方不是最佳的，其中包括选择 错误的药物、剂量、途径或治疗持续时间。该项目将使用实施科学框架来 制定、实施并测试多方面的出院管理干预措施的有效性 住院儿童中抗生素处方的三种最常见适应症 - 社区获得性肺炎 (CAP)、尿路感染 (UTI) 和皮肤/软组织感染 (SSTI) - 在 四家儿童医院为未来扩展到更多目标人群奠定了基础。 将讨论抗生素的选择、剂量、途径和治疗持续时间。目标 1 是开发、本地化和 在四个参与地点实施出院管理干预。综合推广 卫生服务研究实施行动（i-PARIHS）框架将指导快速形成 评估以确定可能促进或阻碍排放实施的背景因素 每个地点的管理干预。根据这些结果，当地协调员将努力制定和 实施出院管理干预措施，包括共识驱动的临床处方指南 CAP、UTI 和 SSTI 以及基于这些指南的处方数据季度反馈。目标 2 是 衡量出院管理干预对抗生素处方的影响（主要结果） 以及以患者为中心的平衡措施。对于主要结果，即次优抗生素处方，我们将 使用回顾性数据收集，利用经过验证的基于诊断代码的算法来最大化 未来传播的一致性和可行性。对于平衡指标、治疗失败和治疗后 排出药物不良事件，我们将使用从 CAP、UTI 患者父母那里收集的前瞻性数据， 和 SSTI 来最大限度地捕获它们。这两个子目标都将利用基于 18 个月的时间序列分析 干预前数据以及干预后 30 个月的数据。该项目将奠定基础 未来将出院管理传播到更广泛的患者群体。调查人员对此 儿科管理共享抗菌报告 (SHARPS) 领导层的提案 Collaborative，一个由北美 60 多家儿童医院组成的独特网络 旨在采取针对出院时处方的抗菌药物管理干预措施。