Demonstration of Near Zero Antibiotic Prescribing for Acute Bronchitis

描述(由申请人提供)：背景：研究表明，指南声明和绩效评估断言，对无并发症的急性支气管炎开抗菌药是不合适的。然而，在美国每年2250万急性支气管炎就诊中，临床医生开出的抗菌药超过60%。以前成功的干预措施虽然在流行病学上很严格，但只将抗菌药物处方率降至40%或50%。目前尚不清楚，在实际操作中，能否将急性支气管炎的抗菌药处方率降至接近零的水平，同时保持患者的安全性和满意度。研究计划：该项目的具体目标1是开发一种用于成人急性支气管炎诊断和治疗的EHR综合算法，目标是将抗菌处方率降低到接近零的水平。具体目标2是在大型、多样化的初级保健实践中对急性支气管炎实施受控的、持续监测的、EHR集成的诊断和治疗算法。我们将使用多模式实施-包括计算机化的决策支持、报告工具和临床医生反馈-以及质量改进技术，以确保遵守算法并将抗菌处方率降至接近0%。主要结果将是急性支气管炎患者的抗菌药处方率。次要结果将包括患者症状、患者满意度、患者安全和医疗成本。为了确保算法和干预措施未来的有效传播，一个主要成果将是捕获和描述对抗菌药物处方率影响最大的成分。具体目标2a是开发一种独立于电子病历的算法和实现方法，用于没有电子病历的诊所。具体目标3是在11个诊所的初级保健实践研究网络中传播算法和实施方法，并将急性支气管炎的抗菌药处方率降低到接近零的水平。未来的方向和影响：在未来，我们计划广泛传播并继续测试EHR依赖和EHR独立版本的算法和实现方法的有效性和安全性。开发、演示和广泛传播一种有效的算法，将急性支气管炎的抗菌药处方减少到接近零的水平，有可能减少美国的不良药物事件、医疗保健成本和抗菌素耐药性细菌的流行。该项目还将检查各种工具的有效性，以改变可推广到其他临床情况的非卧床实践。 与公共卫生相关：抗生素对急性支气管炎患者没有帮助，但在2250万次急性支气管炎就诊中，医生给60%以上的患者开了抗生素，而之前的努力只将抗生素处方率降至约40%。我们建议开发和测试一种急性支气管炎的诊断和治疗算法，将抗生素处方率降低到接近零的水平，确保这对患者是安全的。通过开发、测试和传播这样的算法，我们希望降低医疗成本、药物不良反应和抗生素耐药性细菌的流行率。

DESCRIPTION (provided by applicant): Background: Studies show, guidelines state, and performance measures assert that antimicrobial prescribing for uncomplicated acute bronchitis is inappropriate. However, clinicians prescribe antimicrobials in over 60% of the 22.5 million acute bronchitis visits in the United States each year. Previous successful interventions, while epidemiologically rigorous, have only reduced the antimicrobial prescribing rate to 40% or 50%. It is unknown if the antimicrobial prescribing rate for acute bronchitis can be brought to near zero percent in actual practice while maintaining patient safety and satisfaction. Research Plan: Specific Aim 1 of this project is to develop an EHR-integrated algorithm for the diagnosis and treatment of adults with acute bronchitis with a goal of reducing the antimicrobial prescribing rate to near zero percent. Specific Aim 2 is to perform a controlled, continuously-monitored, implementation of an EHR-integrated diagnosis and treatment algorithm for acute bronchitis in a large, diverse primary care practice. We would use a multi-modal implementation - including computerized decision support, reporting tools, and clinician feedback - and quality improvement techniques to ensure adherence to the algorithm and reduce the antimicrobial prescribing rate to near zero percent. The primary outcome would be the antimicrobial prescribing rate for patients with acute bronchitis. Secondary outcomes would include patient symptoms, patient satisfaction, patient safety, and healthcare costs. To ensure the effective future dissemination of the algorithm and intervention, a major outcome would be the capture and description of the components that had the greatest effect on the antimicrobial prescribing rate. Specific Aim 2a is to develop an EHR-independent version of the algorithm and implementation method for use in clinics that do not have EHRs. Specific Aim 3 is to disseminate the algorithm and implementation method throughout an 11-clinic Primary Care Practice-Based Research Network and reduce the antimicrobial prescribing rate for acute bronchitis to near zero percent. Future Directions and Implications: In the future, we plan to broadly disseminate and continue to test the effectiveness and safety of the EHR-dependent and EHR-independent versions of the algorithm and implementation method. Development, demonstration, and broad dissemination of an effective algorithm to reduce antimicrobial prescribing to near zero percent for acute bronchitis has the potential to decrease adverse drug events, healthcare costs, and the prevalence of antimicrobial resistant bacteria in the United states. This project will also examine the effectiveness of a variety of tools for changing ambulatory practice that can generalize to other clinical conditions. PUBLIC HEALTH RELEVANCE: Antibiotics do not help patients with acute bronchitis, but doctors prescribe antibiotics in over 60% of the 22.5 million visits for acute bronchitis and previous efforts have only reduced the antibiotic prescribing rate to about 40%. We propose to develop and test a diagnosis and treatment algorithm for acute bronchitis that would reduce the antibiotic prescribing rate to near zero percent, making sure this is safe for patients. By developing, testing, and disseminating such an algorithm, we hope to decrease healthcare costs, adverse drug reactions, and the prevalence of antibiotic-resistant bacteria.