Implementing a Discharge Stewardship Bundle to improve antibiotic use at transition from hospital to home

实施出院管理捆绑包以改善从医院到家庭过渡期间抗生素的使用

• 批准号: 10670816
• 负责人: Jeffrey Stephen Gerber
• 金额: $ 48.19万
• 依托单位: CHILDREN'S HOSP OF PHILADELPHIA
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-08-01 至 2025-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10670816
• 关键词: Implementing; Discharge; Stewardship; Bundle; improve

Project Summary / Abstract Pediatric antibiotic stewardship programs (ASPs) in hospital and outpatient settings optimize the use of antibiotics to improve clinical outcomes, decrease adverse drug events, and reduce the emergence of antibiotic resistant bacteria. However, stewardship for patients at the transition from hospital discharge to home, or “discharge stewardship,” is an unmet need for several reasons. First, few pediatric stewardship programs perform discharge stewardship. Second, approximately 30% of pediatric patients receive antibiotics at hospital discharge. Third, the majority of antibiotic days prescribed for hospitalized patients occur after discharge. Fourth, up to half of discharge antibiotic prescriptions are suboptimal, which includes choosing the wrong drug, dose, route, or duration of therapy. This project will use an implementation science framework to develop, implement, and test the effectiveness of a multifaceted discharge stewardship intervention for hospitalized children with the three most common indications for antibiotic prescribing in hospitalized children - community-acquired pneumonia (CAP), urinary tract infections (UTI), and skin/soft tissue infections (SSTI) - at four children's hospitals to establish a foundation for future expansion to additional target populations. Antibiotic choice, dose, route, and duration of therapy will be addressed. Aim 1 is to develop, locally adapt, and implement a discharge stewardship intervention across the four participating sites. The integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework will guide a rapid formative evaluation to identify contextual factors likely to facilitate or hinder the implementation of a discharge stewardship intervention at each site. Based on these results, local facilitators will work to develop and implement a discharge stewardship intervention comprised of consensus driven clinical prescribing guidelines for CAP, UTI, and SSTI plus quarterly feedback of prescribing data based on these guidelines. Aim 2 is to measure the impact of the discharge stewardship intervention on antibiotic prescribing (the primary outcome) and patient-centered balancing measures. For the primary outcome, suboptimal antibiotic prescribing, we will use retrospective data collection leveraging validated diagnostic code-based algorithms to maximize consistency and feasibility for future dissemination. For the balancing metrics, treatment failure and post- discharge adverse drug events, we will use prospective data collection from parents of patients with CAP, UTI, and SSTI to maximize their capture. Both sub-aims will utilize a time series analysis based on 18 months of pre-intervention data followed by 30 months of post-intervention data. This project will form the foundation for future dissemination of discharge stewardship to a broader array of patient populations. Investigators on this proposal form the leadership of the Sharing Antimicrobial Reports for Pediatric Stewardship (SHARPS) Collaborative, a network comprised of more than 60 children's hospitals across North America that is uniquely positioned to adopt antimicrobial stewardship interventions designed to target prescribing at hospital discharge.

项目总结/摘要 医院和门诊环境中的儿科抗生素管理计划（ASP）优化了 抗生素，以改善临床结果，减少药物不良事件，并减少 抗生素抗性细菌。然而，在从出院到出院的过渡期， 由于几个原因，家庭或“出院管理”是一种未得到满足的需求。首先，很少有儿科管理 程序执行出院管理。其次，大约30%的儿科患者接受抗生素治疗 在出院时第三，大多数住院患者的抗生素日发生在 放电第四，多达一半的出院抗生素处方是次优的，其中包括选择 错误的药物、剂量、途径或治疗持续时间。该项目将使用一个实施科学框架， 制定、实施和测试多方面出院管理干预措施的有效性， 住院儿童的三种最常见的抗生素处方适应症- 社区获得性肺炎（CAP），尿路感染（UTI）和皮肤/软组织感染（SSTI）-在 四家儿童医院，为今后扩大到更多的目标人群奠定基础。 将讨论抗生素的选择、剂量、途径和治疗持续时间。目标1是发展，适应当地情况， 在四个参与研究中心实施出院管理干预。一体化促进 卫生服务研究实施行动（i-PARIHS）框架将指导快速形成 评估以确定可能促进或阻碍执行释放的背景因素 每个站点的管理干预。根据这些结果，当地协调员将努力制定和 实施由共识驱动的临床处方指南组成的出院管理干预 CAP、UTI和SSTI，以及基于这些指南的处方数据季度反馈。目标二是 测量出院管理干预对抗生素处方的影响（主要结局） 和以病人为中心的平衡措施。对于主要结局，次优抗生素处方，我们将 使用回顾性数据收集，利用经验证的基于诊断代码的算法， 未来传播的一致性和可行性。对于平衡指标，治疗失败和治疗后 出院药物不良事件，我们将使用来自CAP、UTI患者父母的前瞻性数据收集， 和SSTI来最大化捕获它们。这两个次级目标将利用基于18个月的时间序列分析， 干预前数据，随后是干预后30个月的数据。该项目将为 未来将出院管理推广到更广泛的患者人群。调查人员对此 分享儿科抗菌药物管理报告（Sharing Antimicrobial Reports for Pediatric Stewardship，SHARPS） 协作，一个由北美60多家儿童医院组成的网络， 能够采取抗菌药物管理干预措施，旨在针对出院时的处方。