Standardization of Evaluation to Treatment of pediatric perianal Crohn’s disease and improving Outcomes through Networking (SETON)

儿科克罗恩病治疗标准化评估和通过网络改善治疗结果 (SETON)

• 批准号: 10633930
• 负责人: Jeremy Adler
• 金额: $ 40万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-06-01 至 2028-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10633930
• 关键词: Standardization; Evaluation; Treatment; pediatric; perianal

ABSTRACT Antibiotics are given universally to treat Crohn’s disease, especially with perianal fistulizing complications (PFC), which occur in about 1/3 of children. Decreasing the utilization is challenging, yet significant, as many guidelines support the use of antibiotics as first-line despite a lack of research showing benefit. Furthermore, there is such variation in treatment not only regarding antibiotic use but also around use of other medications, interventions such as drainage, and timing of each of these. In this innovative proposal, the investigators evaluate the current practices for management of PFC in Crohn’s disease at seven large pediatric institutions, develop a protocol to guide antibiotic stewardship, and improve care through a multidisciplinary approach (pediatric gastroenterology, surgery, infectious disease, radiology, and nursing) and prospective implementation arm for data collection and evaluation of barriers and facilitators. Our central hypothesis is that antibiotic use for PFC in Crohn’s disease can be reduced, and outcomes improved through standardization of multidisciplinary care of children. The rationale for this project is that reduction in antibiotic use and providing higher quality care will reduce the risk of developing healthcare-associated infections such as clostridioides difficile, acquiring resistant organisms, and improved care will also reduce the risk of perianal abscess development or fistula recurrence among pediatric patients with Crohn’s disease. We will test our hypothesis through the specific aims: 1) describe variation in antibiotic use and treatment of PFCs among pediatric patients with Crohn’s disease at seven children’s hospitals; 2) develop evidence-based protocols through multidisciplinary, multicenter collaboration aimed at antibiotic reduction and standardization of PFC care; and 3) implement the protocols for antibiotic stewardship and prospectively evaluate the barriers and facilitators with shared insight of best practices for pediatric Crohn’s disease. This approach will create an evidence-base for antibiotic utilization while standardizing the care for pediatric Crohn’s disease at several institutions with prospective evaluation of outcomes. The proposed research is innovative because it brings together multidisciplinary teams from multiple institutions to develop a shared approach to improving care, that is currently not standardized, or evidence-based. The proposed study is significant because it has the potential to change the paradigm for pediatric multidisciplinary care of complex conditions beyond pediatric Crohn’s disease.

摘要 抗生素普遍用于治疗克罗恩病，特别是肛周瘘管并发症（PFC）， 大约三分之一的儿童会出现这种情况。降低利用率具有挑战性，但意义重大，因为许多指导方针 支持将抗生素作为一线药物使用，尽管缺乏显示其益处的研究。此外，还有这样的 治疗的变化不仅涉及抗生素的使用，还涉及其他药物的使用， 例如排水和这些中的每一个的定时。在这项创新的建议中，研究人员评估了目前的 在七个大型儿科机构中管理克罗恩病PFC的实践，制定一项方案， 指导抗生素管理，并通过多学科方法改善护理（儿科胃肠病学， 外科、传染病、放射科和护理）和前瞻性实施部门进行数据收集和 评估障碍和促进因素。我们的中心假设是克罗恩病中PFC的抗生素使用 通过对儿童进行多学科护理的标准化，可以减少儿童死亡率，并改善结果。的 该项目的基本原理是，减少抗生素的使用和提供更高质量的护理将降低 发生医疗保健相关感染，如艰难梭菌，获得耐药微生物，以及 改善护理也将降低儿童肛周脓肿发展或瘘管复发的风险。 克罗恩病患者。我们将通过具体的目标来检验我们的假设：1）描述 7家儿童医院克罗恩病患儿抗生素使用和全氟碳化物治疗; 2)通过针对抗生素的多学科、多中心合作制定循证方案 减少全氟化学品护理并使其标准化;以及3）实施抗生素管理协议， 前瞻性评估障碍和促进因素，并分享儿科克罗恩病最佳实践的见解 疾病这种方法将为抗生素的使用创造一个证据基础，同时标准化治疗。 儿童克罗恩病在几个机构与前瞻性评价的结果。拟议研究 它是创新的，因为它汇集了来自多个机构的多学科团队， 改善护理的方法，目前还没有标准化，或以证据为基础。拟定研究 意义重大，因为它有可能改变复杂的儿科多学科护理的范式。 小儿克罗恩病以外的疾病