Reducing Overuse of Antibiotics at Discharge: The ROAD Home Trial

项目摘要/摘要 出院时减少抗生素过度使用(ROAD)Home试验是一项由40家医院组成的集群随机试验 评估《回家路》实施效果并了解影响实施的因素 干预。在出院时过度使用抗生素是常见的、昂贵的和有害的。虽然以证据为基础 抗生素管理策略的存在是为了改善处方，它们在过渡期间不会到达患者手中 不同的护理环境。出院是一种迫切需要有效管理的护理过渡 可在各种情况下使用的干预措施。在美国，出院时开抗生素 占抗生素使用的一半--以及高达90%的过度使用--与住院有关。释放- 具体的管理策略(例如，出院时的审计和反馈)在优化处方方面是有效的； 然而，它们是资源密集型的，而且通常不可能在具有变量的医院之间实施 资源。因此，迫切需要干预措施来改善出院处方，以适应 因地制宜，可行，对不同的医院有效。为了满足这一需求，回家之路研究小组 制定了回家之路框架，其中规定了以证据为基础的管理战略，以改进 开出抗生素处方。回家之路框架是回家之路的基础 干预，一种参与式干预，支持医院实施循证管理 改善排泄抗生素使用的策略。回家之路干预包括三个组成部分：1) 出院管理需求评估，2)使用回家之路促进战略选择 框架，以及3)实施蓝图。这项研究的总体目标是评估 了解回家之路干预的有效性和实施背景。中环 假设是，参与回家之路干预的医院使用抗生素的天数将会减少 与普通护理医院相比，出院时过度使用。拟议的试验将利用研究人员的 与密歇根医院药物安全合作开展抗生素管理研究取得广泛成功 联盟(HMS)，一个由69家医院组成的团体，致力于改善住院患者的护理。具体目标 (1)在卫生管理系统内，进行一项40间医院的平行联网随机试验，以测试 对CAP和UTI住院成人出院时抗生素滥用天数的回家干预， (2)进行混合方法并行过程评估，以确定影响环境因素 实施道路回家干预，以及(3)创建和细化道路回家流量 管家工具包。当务之急是改善出院时的抗生素处方。在基础上建设 在AHRQ资助的工作之前，本研究将严格评估创新的道路家园干预和 为广泛的国家传播努力提供信息，以确保减少危害和提高质量 对抗生素的管理是公平分配的，无论他们在哪里接受护理，都能接触到所有患者。

PROJECT SUMMARY/ABSTRACT The Reducing Overuse of Antibiotics at Discharge (ROAD) Home trial is a 40-hospital cluster randomized trial to evaluate the effectiveness and understand factors influencing implementation of the ROAD Home intervention. Antibiotic overuse at hospital discharge is common, costly, and harmful. While evidence-based antibiotic stewardship strategies exist to improve prescribing, they are not reaching patients as they transition across care settings. Hospital discharge represents one care transition in critical need of effective stewardship interventions that can be used across a variety of contexts. In the US, antibiotics prescribed at discharge account for half of antibiotic use—and up to 90% of days of overuse—related to hospitalization. Discharge- specific stewardship strategies (e.g., audit and feedback at discharge) are effective at optimizing prescribing; however, they are resource-intensive and often infeasible to implement across hospitals with variable resources. Thus, there is a critical need for interventions to improve discharge prescribing that are tailored to local context, feasible, and effective for diverse hospitals. To address this need, the ROAD Home study team developed the ROAD Home Framework which specifies evidence-based stewardship strategies to improve discharge antibiotic prescribing. The ROAD Home Framework is the foundation for the ROAD Home Intervention, a participatory intervention that supports hospitals in implementing evidence-based stewardship strategies to improve discharge antibiotic use. The ROAD Home Intervention includes three components: 1) discharge stewardship needs assessment, 2) facilitated selection of strategies using the ROAD Home Framework, and 3) an implementation blueprint. The overarching goal of this study is to evaluate the effectiveness and understand the implementation context of the ROAD Home Intervention. The central hypothesis is that hospitals participating in the ROAD Home Intervention will have fewer days of antibiotic overuse at discharge compared to usual care hospitals. The proposed trial will leverage the researcher’s extensive prior success conducting antibiotic stewardship research with the Michigan Hospital Medicine Safety Consortium (HMS), a group of 69 hospitals working to improve care for hospitalized patients. The specific aims are: (1) within HMS, conduct a 40-hospital parallel cluster randomized trial to test the effectiveness of the ROAD Home Intervention on days of antibiotic overuse at discharge in hospitalized adults with CAP and UTI, (2) conduct a mixed-methods concurrent process evaluation to identify contextual factors influencing implementation of the ROAD Home Intervention, and (3) create and refine a ROAD Home discharge stewardship toolkit. There is an urgent need to improve antibiotic prescribing at hospital discharge. Building on prior AHRQ-funded work, this study will rigorously evaluate the innovative ROAD Home Intervention and inform broad national dissemination efforts to ensure that reductions in harm and improvements in quality due to antibiotic stewardship are equitably distributed, reaching all patients regardless of where they receive care.