Defining Measures of Impact for Antimicrobial Stewardship Programs in Community Hospitals

 描述（由申请人提供）：根据世界卫生组织，抗菌素耐药性是“人类健康的三大威胁之一”。这一威胁是由于耐多药病原体的发病率不断增加、新抗菌剂的开发减少以及抗菌剂的不适当使用造成的。鉴于这一紧迫的威胁和 为了提高抗菌药物的使用率，CDC建议美国急性护理医院支持抗菌药物管理计划（ASP）。ASP是质量改进计划，其目标是优化抗菌药物的使用，以实现最佳临床结果，提高患者安全性，限制导致耐药性发展的选择性压力，并降低过度成本。然而，目前还不清楚如何有效地评估，从而优化，抗菌药物管理计划。抗菌药物管理工作的结果指标尚未明确定义或测试。不存在ASP优化的多中心、纵向研究。杜克抗菌药物管理外展网络（DASON）是一个共享数据、教育材料和咨询服务的社区医院协作组，它为研究社区医院的规划发展提供了一个独特的机会。拟议的研究的目标是开发，实施和评估效用的影响的措施，重要的是评估成功的ASP。该提案的具体目标如下：1a）定义抗菌药物管理措施的影响，以确定社区医院需要干预的领域，1b）定义社区医院队列中抗菌药物使用、抗菌药物耐药性和现有抗菌药物管理活动的现状，以及2）定量评估数据反馈对患者结局、ASP目标和活动的影响。这些目标的完成将提供1）迄今为止社区医院抗菌药物使用、耐药性和ASP活动的最完整分析，以及2）已证明对项目开发有用和有效的ASP的影响措施。本研究期间制定的措施将用于未来特定管理干预措施的调查以及国家优化抗菌药物使用的努力。PI的长期目标是成为一名独立的临床医生-科学家，在抗菌药物管理方面进行卫生服务研究。为了实现这一目标，PI将获得先进的统计技能和卫生服务研究方法的知识，这将增强她在医疗流行病学方面的现有专业知识。她的共同导师的密切监督，教学课程，需要领域的两名内部顾问的教程，抗菌管理方面的两名外部专家合作者，以及拟议研究的完成将为她实现这一目标提供必要的要素。

 DESCRIPTION (provided by applicant): Antimicrobial resistance is "one of the three greatest threats to human health," according to the World Health Organization. This threat results from the increasing incidence of multidrug-resistant pathogens, diminishing development of new antimicrobials, and the inappropriate use of antimicrobials. In light of this urgent threat and the potential to improve the use of antimicrobials, the CDC recommends that US acute care hospitals support an antimicrobial stewardship program (ASP). ASPs are quality improvement initiatives with the goal of optimizing antimicrobial use to achieve best clinical outcomes, improve patient safety, limit the selective pressure that drives the development of resistance, and reduce excessive costs. However, it is unclear how to effectively evaluate, and therefore optimize, an antimicrobial stewardship program. Outcome measures for antimicrobial stewardship efforts have not been well-defined or tested. No multicenter, longitudinal studies of ASP optimization exist. The Duke Antimicrobial Stewardship Outreach Network (DASON), a collaborative group of community hospitals that share data, educational materials, and consultative services, provides a unique opportunity to study how programmatic development evolves in community hospitals. The goal of the proposed study is to develop, implement, and evaluate the utility of measures of impact important in assessing the success of ASPs. The specific aims of the proposal are the following: 1a) Define antimicrobial stewardship measures of impact to identify areas in need of intervention at community hospitals, 1b) Define the current state of antimicrobial utilization, antimicrobial resistance, and existing antimicrobial stewardshi activities in a cohort of community hospitals, and 2) Quantitatively assess the effect of data feedback on patient outcomes, ASP goals, and activities. Completion of these aims will provide 1) the most complete analysis of antimicrobial use, resistance, and ASP activities in community hospitals to date, and 2) measures of impact for ASPs that have demonstrated utility and effect on program development. Measures developed during this study will be used in future investigations of specific stewardship interventions as well as national efforts to optimize antimicrobial use. The PI's long-term goal is to become an independent clinician-scientist performing health services research in antimicrobial stewardship. To achieve this goal, the PI will acquire advanced statistical skills and knowledge of health services research methods that will enhance her existing expertise in healthcare epidemiology. Close oversight from her co-mentors, didactic coursework, tutorials with two internal advisors in areas of need, two external expert collaborators in antimicrobial stewardship, and completion of the proposed study will provide the necessary elements for her to achieve this goal.