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Optimizing Antimicrobial Use in Maintenance Dialysis Units (OPTIMUS)

优化维持性透析装置中的抗菌药物使用 (OPTIMUS)

基本信息

批准号：
10641882
负责人：
ERIKA M D'AGATA
金额：
$ 40.22万
依托单位：
MIRIAM HOSPITAL
依托单位国家：
美国
项目类别：
财政年份：
2020
资助国家：
美国
起止时间：
2020-07-01 至 2025-06-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10641882
关键词：
Optimizing Antimicrobial Use Maintenance Dialysis

项目摘要

Rates of multidrug-resistant organisms (MDRO) are among the highest in persons requiring maintenance hemodialysis (MHD). Antimicrobial exposure is the main risk factor for the emergence and spread of MDRO. Up to 30% of antimicrobials administered in out-patient dialysis facilities are not indicated. Decreasing inappropriate, unnecessary or suboptimal antimicrobial use in dialysis facilities is therefore crucial. We recently published a decision analytic model on the clinical and economic consequences of implementing antimicrobial stewardship programs (ASP) in out-patient dialysis facilities nation-wide. The model predicted a 4.8% reduction in infections caused by MDRO and Clostridium difficile; a 4.6% reduction in infection-related deaths and a 5.0% reduction in costs. In 2017, the PI completed an AHRQ-funded study of an ASP in out-patient dialysis facilities. The program, which focused on educational and behavioral strategies, resulted in a reduction in antimicrobial use (P=0.02). Although successful, three barriers to even greater effective prescribing were identified. First, our initial ASP method could not fully identify inappropriate doses, administered after the empiric doses, in a timely manner. Thus, opportunities for improving prescribing were missed. Second, approximately 55% of doses prescribed were from orders received from the transferring hospital upon hospital discharge. Data pertaining to the indications for and choice of antimicrobial therapy were minimal and thereby limited the number of opportunities to improve antimicrobial prescribing. Third, engagement from unit medical directors was minimal. Lack of leadership support likely prevented the ASP to be more effective. With this foundation and leveraging a research infrastructure established during our previous AHRQ grant, this proposal, entitled OPTIMUS (Optimizing Antimicrobial Use In Maintenance Dialysis UnitS), will develop and implement an improved ASP. In addition to the previous educational and behavioral components, specific tools and strategies to overcome the three barriers mentioned above will be developed and implemented in this improved ASP. These tools include an antimicrobial hospital transfer report and an evidence-based checklist for antimicrobial prescribing in the dialysis facilities. We will enroll DaVita dialysis units and have already obtained leadership support. Our interdisciplinary team includes investigators with expertise in ASP and implementation science, senior nephrologists with experience in quality improvement initiatives and our CDC consultant, with expertise in MHD healthcare quality. An interrupted time series design will be used in 8 intervention and 8 control units. Specific aims are:1] To develop and implement an improved ASP in out-patient hemodialysis units, 2] To demonstrate the effectiveness of this ASP in reducing antimicrobial use, and 3] To develop a dialysis setting specific-antimicrobial prescribing audit tool and demonstrate improvement in the quality of antimicrobial prescribing patterns as a result of the ASP. Demonstrating the efficacy of this ASP and generating tools to assist in optimizing antimicrobial prescribing will provide an unmet and overdue need in the MHD population and will ultimately improve their health outcomes.

在需要维持治疗的人群中，多重耐药微生物（MDRO）的比例最高血液透析（MHD）。抗菌药物暴露是MDRO发生和传播的主要危险因素。起来到30%的门诊透析机构使用的抗菌剂不适用。减少不适当的，因此，在透析设施中不必要的或次优的抗菌剂使用是至关重要的。我们最近发布了一份实施抗菌药物管理的临床和经济后果的决策分析模型在全国范围内的门诊透析设施中实施ASP计划。该模型预测感染率降低4.8% 由MDRO和艰难梭菌引起的感染;感染相关死亡减少4.6%，成本2017年，PI完成了一项由AHRQ资助的ASP在门诊透析机构中的研究。该计划，注重教育和行为策略，导致抗菌药物使用减少（P=0.02）。虽然成功，三个障碍，甚至更有效的处方被确定。首先，我们的初始ASP 方法不能完全识别不适当的剂量，给药后的经验剂量，及时。因此，错过了改善处方的机会。其次，大约55%的处方剂量来自出院时从转院医院收到的医嘱。相关数据抗菌治疗的适应症和选择很少，因此限制了机会的数量。来改善抗生素处方。第三，单位医务主任的参与很少。缺乏领导层的支持可能会阻止ASP更有效。有了这个基础，在我们以前的AHRQ赠款期间建立的基础设施，这项名为OPTIMUS（优化）的提案抗菌剂在维持透析装置中的使用），将开发和实施一个改进的ASP。除了以前的教育和行为组成部分，克服这三个障碍的具体工具和战略上述内容将在此改进的ASP.这些工具包括一种抗菌剂，医院转移报告和透析机构抗菌药物处方的循证清单。我们将招募DaVita透析单位，并已获得领导支持。我们的跨学科团队包括具有ASP和实施科学专业知识的研究者，具有质量管理经验的高级肾病学家改进计划和我们的CDC顾问，在MHD医疗保健质量方面具有专业知识。中断的时间将在8个干预单元和8个控制单元中使用串联设计。具体目标是：1）制定和实施在门诊血液透析单位中改进ASP，2]为了证明该ASP在降低抗菌药物使用，以及3]开发透析环境特异性抗菌药物处方审核工具，证明由于ASP，抗菌药物处方模式的质量有所改善。证明该ASP的有效性并生成有助于优化抗菌药物处方的工具，为MHD人群提供未满足和逾期的需求，并最终改善他们的健康结果。