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.

多药抗性生物（MDRO）的速度是需要维护的人之一血液透析（MHD）。抗菌暴露是MDRO出现和扩散的主要危险因素。向上未指出在门诊透析设施中给药的30％的抗菌药物。减少不合适的因此，透析设施中的不必要或次级抗菌用途至关重要。我们最近发表了关于实施抗菌管理的临床和经济后果的决策分析模型全国门诊透析设施中的计划（ASP）。该模型预测感染降低了4.8％由MDRO和艰难梭菌引起；与感染相关的死亡减少了4.6％，减少了5.0％费用。 2017年，PI完成了对门诊透析设施中ASP的一项AHRQ资助的研究。该程序，侧重于教育和行为策略，导致抗菌使用的减少（p = 0.02）。尽管成功，但确定了三个更大有效的处方的障碍。首先，我们的初始ASP 方法无法完全及时地识别出经验剂量后给药的不适当剂量。因此，错过了改善处方的机会。第二，大约55％的处方剂量是从住院后从转移医院收到的命令。与抗菌治疗的适应症和选择很少，从而限制了机会的数量改善抗菌处方。第三，单位医疗董事的参与度很小。缺乏领导支持可能会阻止ASP更有效。有了这个基础并利用研究在我们以前的AHRQ赠款中建立的基础架构，该提案标题为“擎天柱”（优化在维护透析单元中使用抗菌剂），将开发和实施改进的ASP。此外以前的教育和行为组成部分，特定的工具和策略来克服这三个障碍上面提到的将在此改进的ASP中开发和实施。这些工具包括抗菌素医院转移报告和透析设施中抗菌处方的循证清单。我们将招募达维塔透析单位，并已经获得了领导支持。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人员，具有质量经验的高级肾病学家改进计划和我们的CDC顾问，具有MHD Healthcare质量的专业知识。一个中断的时间系列设计将用于8个干预和8个控制单元。具体目标是：1]开发和实施在门诊血液透析单元中改进的ASP，2]，以证明该ASP在还原方面的有效性抗菌使用，以及3]来开发透析设置特定的抗菌处方审计工具和证明由于ASP而改善了抗菌处方模式的质量。证明该ASP的功效和生成工具以帮助优化抗菌处方在MHD人群中提供未满足和逾期的需求，并最终会改善其健康状况。