Epicenter V: Harvard Pilgrim Health Care Institute Center for Excellence in HAI Surveillance and Prevention

Epicenter V：哈佛 Pilgrim 医疗保健研究所 HAI 监测和预防卓越中心

• 批准号: 10655385
• 负责人: Michael Klompas
• 金额: $ 152.72万
• 依托单位: HARVARD PILGRIM HEALTH CARE, INC.
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-06-01 至 2026-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10655385
• 关键词: Epicenter; Harvard; Pilgrim; Health; Care

Abstract Epicenter V: Harvard Pilgrim Health Care Institute Center for Excellence in HAI Surveillance and Prevention: Core Projects This Epicenter will pursue six aims to develop essential information to guide improved management of sepsis, non-ventilator hospital acquired pneumonia, and prevention of C. difficile infection among hospital inpatients. The sepsis work will be grounded in analyses of electronic health record data from 300 hospitals drawn from HCA Healthcare and Cerner’s HealthFacts database, together covering the years 2013 through 2019, and involving 1 million sepsis admissions. These studies will use advanced causal inference methods to address three major questions with direct relevance both to management of sepsis and to national mandates and reimbursement policies. These questions are: 1) How does severity of illness at presentation affect the relationship between time-to-antibiotic and survival among patients with bloodstream infections? 2) How common and serious are adverse effects of short course empiric antibiotic therapy among patients with suspected sepsis who prove to have non-infectious conditions? 3) What are the consequences of failure to de- escalate empiric antibiotics prescribed for suspected sepsis after infection is ruled out? The first non-ventilator hospital acquired pneumonia (NV-HAP) aim will address a critical unknown about this common and frequently fatal condition – to what extent are NV-HAP associated deaths preventable? This assessment will use previously validated methods by which expert clinicians review full text medical records from both teaching and community hospitals to determine the cause of death and to determine its relationship to NV-HAP. These findings will inform the urgency of implementing national surveillance and reporting of NV-HAP occurrence, and of designing and testing mitigation strategies. The second NV-HAP aim will design and test a pharmacist led opt-out protocol for discontinuing antibiotics for the 20% of inpatients diagnosed with NV-HAP who have normal clinical signs. This randomized trial will be powered to assess the impact on antibiotic utilization and lay the groundwork for a later definitive trial of the impact on patient outcomes. The final aim will address methods for preventing hospital-onset C. difficile infection amongst high risk patients. We will identify patients colonized with C. difficile via PCR testing of VRE surveillance swabs obtained on admission. Colonized patients in the intervention period will receive a prevention bundle including antibiotic and antacid stewardship as well as consideration of prophylactic probiotics and oral vancomycin.

摘要 震中五：哈佛朝圣者卫生保健研究所中心， 卓越的HAI监测和预防：核心项目 该中心将致力于实现六个目标，以开发必要的信息，指导改进对 败血症、非呼吸机医院获得性肺炎以及C.医院内难治性感染 住院病人 脓毒症工作将基于对300家医院电子健康记录数据的分析， 来自HCA Healthcare和Cerner的HealthFacts数据库，涵盖2013年至2019年，以及 涉及100万败血症入院。这些研究将使用先进的因果推理方法来解决 与脓毒症管理和国家授权直接相关的三个主要问题， 报销政策。这些问题是：1）疾病的严重程度如何影响 血流感染患者使用抗生素的时间与生存率之间的关系？2)如何 短期经验性抗生素治疗的不良反应是常见和严重的， 疑似脓毒症的人证明有非感染性条件？3)如果不这样做的后果是什么- 在排除感染后，增加为疑似脓毒症开具的经验性抗生素？ 首个非呼吸机医院获得性肺炎（NV-HAP）目标将解决一个关键的未知问题 关于这种常见且经常致命的疾病-NV-HAP相关死亡在多大程度上是可以预防的？ 该评估将使用先前经过验证的方法，专家临床医生通过这些方法审查全文医疗信息。 从教学和社区医院的记录，以确定死亡原因，并确定其 与NV-HAP的关系这些发现将说明实施国家监测的紧迫性， 报告NV-HAP的发生，以及设计和测试缓解策略。 NV-HAP的第二个目标是设计和测试一个药剂师主导的选择退出协议， 20%的临床症状正常的NV-HAP住院患者使用抗生素。这项随机 这项试验将评估对抗生素使用的影响，并为以后的决定性研究奠定基础。 对患者结局影响的试验。 最终的目标是解决预防医院发病的方法。高危人群中的艰难感染 患者我们将确定患者的C殖民。通过VRE监测拭子的PCR检测艰难梭菌 入场时获得。在干预期间，定植患者将接受预防包，包括 抗生素和抗酸剂管理以及预防性益生菌和口服万古霉素的考虑。