Optimizing Antimicrobial Use in Maintenance Dialysis Units (OPTIMUS)

优化维持性透析装置中的抗菌药物使用 (OPTIMUS)

• 批准号: 10816199
• 负责人: ERIKA M D'AGATA
• 金额: $ 41.66万
• 依托单位: MIRIAM HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-07-01 至 2025-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10816199
• 关键词: Optimizing; Antimicrobial; Use; Maintenance; Dialysis

Rates of multidrug-resistant organisms (MDRO) are among the highest in persons requiring maintenance hemodialysis (MHD). Antimicrobial exposure is the main risk factor for the emergence and spread of MDRO. Up to 30% of antimicrobials administered in out-patient dialysis facilities are not indicated. Decreasing inappropriate, unnecessary or suboptimal antimicrobial use in dialysis facilities is therefore crucial. We recently published a decision analytic model on the clinical and economic consequences of implementing antimicrobial stewardship programs (ASP) in out-patient dialysis facilities nation-wide. The model predicted a 4.8% reduction in infections caused by MDRO and Clostridium difficile; a 4.6% reduction in infection-related deaths and a 5.0% reduction in costs. In 2017, the PI completed an AHRQ-funded study of an ASP in out-patient dialysis facilities. The program, which focused on educational and behavioral strategies, resulted in a reduction in antimicrobial use (P=0.02). Although successful, three barriers to even greater effective prescribing were identified. First, our initial ASP method could not fully identify inappropriate doses, administered after the empiric doses, in a timely manner. Thus, opportunities for improving prescribing were missed. Second, approximately 55% of doses prescribed were from orders received from the transferring hospital upon hospital discharge. Data pertaining to the indications for and choice of antimicrobial therapy were minimal and thereby limited the number of opportunities to improve antimicrobial prescribing. Third, engagement from unit medical directors was minimal. Lack of leadership support likely prevented the ASP to be more effective. With this foundation and leveraging a research infrastructure established during our previous AHRQ grant, this proposal, entitled OPTIMUS (Optimizing Antimicrobial Use In Maintenance Dialysis UnitS), will develop and implement an improved ASP. In addition to the previous educational and behavioral components, specific tools and strategies to overcome the three barriers mentioned above will be developed and implemented in this improved ASP. These tools include an antimicrobial hospital transfer report and an evidence-based checklist for antimicrobial prescribing in the dialysis facilities. We will enroll DaVita dialysis units and have already obtained leadership support. Our interdisciplinary team includes investigators with expertise in ASP and implementation science, senior nephrologists with experience in quality improvement initiatives and our CDC consultant, with expertise in MHD healthcare quality. An interrupted time series design will be used in 8 intervention and 8 control units. Specific aims are:1] To develop and implement an improved ASP in out-patient hemodialysis units, 2] To demonstrate the effectiveness of this ASP in reducing antimicrobial use, and 3] To develop a dialysis setting specific-antimicrobial prescribing audit tool and demonstrate improvement in the quality of antimicrobial prescribing patterns as a result of the ASP. Demonstrating the efficacy of this ASP and generating tools to assist in optimizing antimicrobial prescribing will provide an unmet and overdue need in the MHD population and will ultimately improve their health outcomes.

在需要维持治疗的人群中，多重耐药菌 (MDRO) 的发生率是最高的 血液透析（MHD）。抗菌药物暴露是多重耐药菌出现和传播的主要危险因素。向上 门诊透析设施中使用的抗菌药物中有 30% 没有被指出。减少不适当的， 因此，在透析设施中不必要或次优使用抗菌药物至关重要。我们最近发布了 实施抗菌药物管理的临床和经济后果的决策分析模型 全国门诊透析机构的项目 (ASP)。该模型预测感染人数将减少 4.8% 由MDRO和艰难梭菌引起；感染相关死亡人数减少 4.6%，感染相关死亡人数减少 5.0% 成本。 2017 年，PI 完成了一项由 AHRQ 资助的门诊透析设施 ASP 研究。该计划， 重点关注教育和行为策略，导致抗菌药物使用减少（P=0.02）。 尽管取得了成功，但仍发现了阻碍更有效处方的三个障碍。一、我们最初的ASP 该方法无法完全及时识别经验剂量后施用的不适当剂量。 因此，错过了改进处方的机会。其次，约 55% 的处方剂量 出院时从转院医院收到的命令。相关数据 抗菌治疗的适应症和选择很少，因此限制了机会的数量 改善抗菌药物处方。第三，单位医疗主管的参与度很低。缺乏 领导层的支持可能会阻碍 ASP 变得更加有效。在此基础上并利用研究 我们之前的 AHRQ 拨款期间建立的基础设施，该提案名为 OPTIMUS（优化 维持透析装置中抗菌剂的使用）将开发并实施改进的 ASP。此外 先前的教育和行为组成部分、克服这三个障碍的具体工具和策略 上述内容将在本改进的ASP中得到开发和实现。这些工具包括抗菌剂 医院转院报告和透析设施抗菌药物处方循证清单。我们 将招募 DaVita 透析单位并已获得领导支持。我们的跨学科团队包括 具有 ASP 和实施科学专业知识的研究人员、具有质量经验的高级肾脏病专家 改进计划和我们的 CDC 顾问，他们在 MHD 医疗保健质量方面拥有专业知识。被中断的时间 8个干预单元和8个控制单元将采用串联设计。具体目标是：1] 制定和实施 门诊血液透析室中改进的 ASP，2] 为了证明该 ASP 在减少 抗菌药物的使用，以及 3] 开发透析环境特定抗菌药物处方审核工具和 证明 ASP 提高了抗菌药物处方模式的质量。 展示该 ASP 的功效并生成工具来协助优化抗菌药物处方将 为 MHD 人群提供未满足和逾期的需求，并最终改善他们的健康状况。