Reducing Overuse of Antibiotics at Discharge: The ROAD Home Trial

项目总结/摘要 减少出院时抗生素过度使用（ROAD）家庭试验是一项40家医院的随机分组试验 评估ROAD Home的有效性并了解影响其实施的因素 干预出院时过度使用抗生素是常见的、昂贵的和有害的。虽然基于证据 抗生素管理策略存在，以改善处方，他们没有达到病人，因为他们过渡 在护理环境中。出院代表了一种迫切需要有效管理的护理过渡 可以在各种情况下使用的干预措施。在美国，出院时开的抗生素 占抗生素使用量的一半--以及高达90%的过度使用天数--与住院有关。解除─ 具体的管理策略（例如，出院时的审计和反馈）有效优化处方; 然而，它们是资源密集型，且通常不可行， 资源因此，迫切需要干预措施来改善出院处方， 当地情况下，可行的，有效的不同的医院。为了满足这一需求，ROAD Home研究团队 制定了ROAD Home框架，该框架规定了以证据为基础的管理战略，以改善 出院抗生素处方。ROAD Home框架是ROAD Home的基础 干预，支持医院实施循证管理的参与性干预 改善出院抗生素使用的策略。ROAD家庭干预包括三个组成部分： 出院管理需求评估，2）促进使用ROAD Home的策略选择 （3）实施蓝图。本研究的总体目标是评估 有效性，并了解道路家园干预的实施背景。中央 假设参与ROAD家庭干预的医院使用抗生素的天数会减少 与常规护理医院相比，出院时过度使用。拟议的试验将利用研究人员的 与密歇根医院医学安全部合作开展抗生素管理研究取得了广泛的成功 联盟（HMS），一个由69家医院组成的组织，致力于改善住院患者的护理。具体目标 （1）在HMS中，进行一项40家医院的平行分组随机试验，以测试 ROAD家庭干预对CAP和UTI住院成人出院时抗生素过度使用天数的影响， (2)进行混合方法并行过程评估，以确定影响 实施ROAD Home干预，以及（3）创建和完善ROAD Home排放 管理工具包。目前迫切需要改善出院时的抗生素处方。基础上 之前AHRQ资助的工作，这项研究将严格评估创新的道路家园干预， 为更广泛的国家传播工作提供信息，以确保减少危害和提高质量， 公平分配抗生素管理，惠及所有患者，无论他们在哪里接受治疗。

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.