Defining Measures of Impact for Antimicrobial Stewardship Programs in Community Hospitals

 描述(申请人提供)：根据世界卫生组织的说法，抗菌素耐药性是“对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 为了提高抗菌素使用的潜力，疾控中心建议美国急性护理医院支持抗菌素管理计划(ASP)。ASP是一种质量改进举措，其目标是优化抗菌药物的使用，以实现最佳的临床结果，提高患者的安全性，限制导致耐药性发展的选择压力，并降低过高的成本。然而，目前还不清楚如何有效地评估并优化抗菌药物管理计划。抗菌管理工作的结果措施尚未得到很好的定义或测试。目前还没有关于ASP优化的多中心纵向研究。杜克大学抗菌药物管理外展网络(DASON)是一个由社区医院组成的合作组织，共享数据、教育材料和咨询服务，为研究社区医院的规划发展提供了一个独特的机会。拟议研究的目标是制定、实施和评估影响措施的效用，这些措施对评估战略规划的成功非常重要。该提案的具体目标如下：1a)确定影响的抗菌药物管理措施，以确定社区医院需要干预的领域；1b)确定社区医院队列中抗菌素利用、抗菌素耐药性和现有抗菌药物管家活动的当前状态；以及2)定量评估数据反馈对患者结果、ASP目标和活动的影响。这些目标的完成将提供1)迄今为止对社区医院中的抗菌剂使用、耐药性和ASP活动的最完整的分析，以及2)对已证明对项目发展的效用和效果的ASP的影响的措施。在本研究期间制定的措施将用于今后对具体管理干预措施的调查，以及优化抗菌剂使用的国家努力。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。为达致这个目标，私隐专员将学习先进的统计技能和医疗服务研究方法的知识，以加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、在有需要的领域由两名内部顾问提供的教程、两名外部抗菌药物管理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.