Using Large Observational Datasets to Improve Antibiotic Prescribing for Community-Acquired Pneumonia

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Project Summary Dr. Deshpande is a junior faculty member at the Medicine Institute Center for Value-Based Care Research, Assistant Staff in the Departments of Internal Medicine and Infectious Diseases at Cleveland Clinic, and an Assistant Professor of Medicine at the Cleveland Clinic Lerner College of Medicine at Case Western Reserve University, Cleveland, OH. The goal of this career development award is to provide training in health services research, including mentored application of rigorous research methods to identify effective diagnostic and treatment strategies for patients with CAP. Through his current project, he will add to our understanding of antimicrobial therapy for CAP. Future projects will apply these findings to design interventions that help clinicians make better antibiotic choices. His long term goal is to become a leading clinical researcher performing health services research in infectious diseases. Despite being one of the leading causes of hospitalization in the US, there remain many unanswered questions regarding the optimal diagnosis and treatment of CAP. CAP continues to be a leading cause of hospitalization and death in the United States. Growing antimicrobial resistance nationally further complicates the selection of an appropriate initial therapeutic regimen. Physicians must ensure that patients with CAP caused by resistant organisms receive appropriate treatment, while minimizing overuse of broad-spectrum antibiotics. Given its enormous impact and the increasing prevalence of antibiotic resistance there is a critical need for research efforts focused on identifying the changing microbial etiology and the best practices for CAP antimicrobial therapy. In this career development award, Dr. Deshpande proposes to study 3 questions and in so doing will acquire new research methods and experience working with 3 distinct large datasets. The questions are as follows: 1) What are the current epidemiology and antibiotic resistance patterns of CAP in the US? 2) What is the relationship between local antibiotic resistance patterns, physician prescribing and patient outcomes? And 3) Does early switch therapy from intravenous to oral antibiotics reduce length of stay (LOS) and cost without increasing treatment failure or readmissions. The proposed career development plan incorporates advanced training in infectious disease epidemiology, comparative effectiveness and large database cohort studies, as well as closely mentored research. His very strong mentorship team is led by Dr. Rothberg, who is an established outcomes researcher with an interest in healthcare associated pneumonia and supported through federal funding. The proposed series of investigations, using a rich dataset derived from 3 large databases, will generate important new knowledge about CAP management practices and associated patient outcomes. The research speaks directly to President Obama’s recent initiative: “National Strategy for Combating Antibiotic-Resistant Bacteria”.