Informatics Approaches to Understand and Reduce Inappropriate Antibiotic Prescribing by Dentists

了解和减少牙​​医不适当抗生素处方的信息学方法

• 批准号: 10736908
• 负责人: D. Brad Rindal
• 金额: $ 71.01万
• 依托单位: UNIVERSITY OF TEXAS HLTH SCI CTR HOUSTON
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-08-01 至 2028-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10736908
• 关键词: Adverse event; Aftercare; Algorithms; Allergic Reaction; American Dental Association; Antibiotic Prophylaxis; Antibiotics; Antimicrobial Resistance; Behavior; Characteristics; Clinic; Clinical; Data; Dental; Dental Care; Dental General Practice; Dental Informatics; Dentistry; Dentists; Development; Diagnosis; Discipline; Electronic Health Record; Engineering; Environment; Feedback; Fostering; Funding; Future; Goals; Group Practice; Guidelines; Health; Health system; Healthcare; Human; Infection; Informatics; Institution; Intervention; Interview; Knowledge; Learning; Measures; National Institute of Dental and Craniofacial Research; Occupations; Oral health; Outcome; Patients; Performance; Pharmacology; Procedures; Process; Productivity; Prophylactic treatment; Provider; Qualifying; Recommendation; Research; Safety; Support System; System; Testing; Time; United States Agency for Healthcare Research and Quality; Visit; Work; arm; clinical decision support; computerized; dashboard; design; electronic health data; evidence base; health care quality; high risk; human centered design; improved; informatics infrastructure; innovation; medical specialties; novel strategies; preservation; prophylactic; synergism; tool; uptake

Informatics Approaches to Understand and Reduce Inappropriate Antibiotic Prescribing by Dentists Project Summary Although antibiotics (ABx) have saved many lives, their inappropriate use contributes to antimicrobial resistance. Overprescribing ABx can also lead to allergic reactions and adverse events (AEs) such as Clostridiodes difficile infection (CDI). Antibiotic stewardship reduces negative health effects of ABx use, thus preserving its future utility and is supported by the American Dental Association (ADA). Antibiotic prophylaxis prior to dental procedures should be reserved for patients at high risk of post-treatment complications. Despite these recommendations, inappropriate ABx prescribing for prophylaxis before dental procedures is common, with 70-80% of prophylactic ABx prescribed outside guidelines Our group has conducted relevant pivotal work and have found that dentistry lags in fostering the uptake of research-informed treatments. We have found that initiatives to improve evidence-based dental practice are often developed and implemented without a deep understanding of the problem, including reasons why dentists deviate from established prescribing guidelines. Our long-term goal is to build a sustainable national dental Learning Health System (LHS) focused on continuous quality improvement that facilitates providing patients with high quality, affordable, evidence-based oral healthcare. To do this, we first need to establish a practice-level LHS supported by an effective informatics infrastructure, relevant data governance and a culture of learning that drives evidence-based dental practice. In this project, we seek to quantify and understand guideline discordant antibiotic prescribing, and to iteratively develop improvement strategies to appropriately target prescribing to the right patients with the right ABx at the right time. Through a deep understanding of why antibiotics are so frequently prescribed outside of the guidelines, we expect to engage the dental team and patients to develop feasible interventions. We will conduct the research at two large group practices: HealthPartners (HP) and Willamette Dental Group (WDG) which together have over 900,000 patient visits per year. Our project team comprises of experts in dental informatics, pharmacology, healthcare quality and safety, and human factors. In Aim 1, we develop and validate an EHR-based algorithm/quality measure to determine concordance with current evidence-based antibiotic prescribing guidelines. In Aim 2, we identify and understand factors associated with guideline concordant/discordant prescribing of antibiotics through patient and provider interviews, and targeted clinic observations. In Aim 3, using a participatory human-centered design process, we design improvement strategies to increase concordance with evidence-based ABx guidelines. The outcomes of our research will arm the dental field with both the knowledge and know-how to measure and reduce inappropriate ABx prescribing by dentists resulting in better oral health, and subsequently better general health, for our patients.

理解和减少牙科医生不恰当使用抗生素的信息学方法 项目摘要 虽然抗生素(ABX)挽救了许多人的生命，但不适当的使用有助于抗菌剂的使用 抵抗。过量服用ABX还会导致过敏反应和不良反应(AEs)，如 艰难梭菌感染(CDI)。抗生素的管理减少了ABX使用对健康的负面影响，因此 保护其未来的效用，并得到美国牙科协会(ADA)的支持。抗生素预防 牙科手术前应保留给治疗后并发症高危患者使用。尽管 这些建议，在牙科手术之前不适当的ABX处方用于预防是常见的， 有70%-80%的预防性ABX是在指南外开的 我们课题组进行了相关的关键工作，发现牙科在培养 采用研究知情的治疗方法。我们发现，改善循证牙科的举措 实践往往是在没有深入了解问题的情况下制定和实施的，包括原因 为什么牙医会偏离既定的处方指南。我们的长期目标是建设一个可持续发展的 国家牙科学习健康系统(LHS)专注于持续质量改进，以促进 为患者提供高质量、经济实惠、循证的口腔保健。要做到这一点，我们首先需要 建立实践级别的LHS，由有效的信息学基础设施、相关数据治理提供支持 以及一种以循证为基础的牙科实践的学习文化。 在这个项目中，我们试图量化和理解指南中不一致的抗生素处方，并 反复制定改进策略，以适当的目标向正确的患者开出处方 ABX在正确的时间。通过深入了解为什么抗生素经常在户外开出 根据指南，我们希望让牙科团队和患者共同制定可行的干预措施。我们会 在两个大型团队实践中进行研究：HealthPartners(HP)和Willamette Dental Group(WDG) 这两家医院每年总共有超过90万名患者就诊。我们的项目团队由牙科专家组成 信息学、药理学、医疗质量和安全以及人为因素。在目标1中，我们开发和 验证基于EHR的算法/质量度量，以确定与当前基于证据的一致性 抗生素处方指南。在目标2中，我们确定并理解与指南相关的因素 通过患者和提供者面谈以及有针对性的诊所开出一致/不一致的抗生素处方 观察。在目标3中，使用参与式以人为中心的设计过程，我们进行了设计改进 增加与循证ABX指南一致性的策略。我们的研究成果将 用知识和诀窍武装牙科领域，测量和减少不适当的ABX 由牙医开出的处方为我们的患者带来了更好的口腔健康，随后也带来了更好的整体健康。