Optimizing Antibiotic Use in Long-Term Care

描述：这项研究的主要目的是确定一种基于证据的临床算法，用于管理居住长期护理设施(LTCFs)中的老年人尿路感染(UTI)，是否可以减少LTCFs中抗生素的总体使用。三个次要目标是：1)论证在LTCFs中实施基于诊断和治疗证据的临床算法的可行性；2)评估在目标人群中减少UTIs诊断测试和抗生素使用的安全性；3)评估在LTCFs中采用这些算法的过程。 这项研究将使用定量和定性相结合的方法来评估在住宅LTCFs中实施优化抗生素使用的临床算法的过程和结果。对于研究的定量部分，使用了随机配对设计，在12对LTCFs中的每一对中，有一对被随机分配到干预(临床算法)。另一半是为推定的尿路感染提供“常规”治疗。量化结果包括1)为泌尿系统适应症开出的抗生素疗程的比例，2)抗生素使用疗程的总数，3)订购的尿培养的比率，4)尿路感染的住院率，5)死亡率。这项研究的定性部分将是对临床算法的前瞻性案例研究评估。这项研究的这一部分将检验实施的简便性和医疗保健提供者对算法的满意度。 这项研究是由AHRQ在2000年10月根据TRIP-II计划资助的。临床试验正在进行中，数据收集计划于2003年5月完成。正在申请更多资金，以完成该研究的数据收集和质量部分。

DESCRIPTION: The primary aim of this study is to determine if an evidence-based clinical algorithm for managing urinary tract infections (UTIs) in older adults in residential long-term care facilities (LTCFs) can reduce the overall use of antibiotics in LTCFs. Three secondary objectives are: 1) to demonstrate the feasibility of implementing diagnostic and therapeutic evidence-based clinical algorithms in LTCFs; 2) to assess the safety of reducing the number of diagnostic tests and antibiotic use for UTIs in the target population; 3) to evaluate the process of adopting the algorithms in LTCFs. This study will use a combined quantitative and qualitative approach to evaluate the process and outcomes of implementing a clinical algorithm to optimize the use of antibiotics in residential LTCFs. For the quantitative component of the study, a randomized matched-pair design has been used where, within each of the 12 pairs of LTCFs, one was randomized to the intervention (clinical algorithm). The other half is providing "usual" management of presumptive urinary tract infections. Quantitative outcomes include 1) the proportion of antibiotic courses prescribed for urinary indications, 2) the total number of courses of antibiotics used, 3) rates of urine cultures ordered, 4) hospitalization rates for urinary tract infections, and 5) mortality rates. The qualitative component of the study will be a prospective case study evaluation of the clinical algorithms. This component of the study will exam the ease of implementation and health care provider satisfaction with the algorithms. This study was funded by AHRQ under the TRIP-II program in October 2000. The clinical trial is in progress and data collection is scheduled to be complete in May 2003. Additional funds are being requested to complete the data collection and qualitative components of the study.