Using CER to Improve Antibiotic Prescribing and Outcomes in Children

利用 CER 改善儿童抗生素处方和治疗效果

• 批准号: 8747637
• 负责人: Adam L. Hersh
• 金额: $ 16.02万
• 依托单位: UNIVERSITY OF UTAH
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-08-01 至 2019-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8747637
• 关键词: Using; CER; Improve; Antibiotic; Prescribing

DESCRIPTION (provided by applicant): The proposed career development award is designed to support the transition of Dr. Adam L. Hersh into an independent physician-scientist using comparative-effectiveness research (CER) methods applied to a patient- centered outcomes research (PCOR) agenda that is dedicated to improving the appropriateness, quality, and safety of antibiotic use of in pediatric care. Dr. Hersh is a pediatric infectious diseases specialist at he University of Utah. The next steps in his career development are to gain advanced skills in quality improvement, epidemiologic, and biostatistical methods for CER and health economics. Dr. Hersh has assembled a mentoring and advisory team with expertise that spans these areas. His AHRQ K08 application proposes 3 research and 4 career development aims that will collectively enable him to become a leader in the areas of antimicrobial stewardship and CER methods in pediatric infectious diseases. Dr. Hersh's application addresses the growing health and economic threat of antibiotic resistance, which is driven in part by the problem of antibiotic overuse. Two important areas of antibiotic overuse include (1) the use of broad-spectrum antibiotics instead of equally effective narrow- spectrum therapy, especially for respiratory infections such as pneumonia; and (2) the use of outpatient parenteral antibiotic therapy (OPAT) instead of equally effective, safer, and less costly oral therapy. The development and implementation of antimicrobial stewardship programs (ASPs) are key strategies to address antibiotic overuse in these areas. However, pediatric ASPs are limited by a weak evidence-base, particularly pertaining to their effectiveness in facilitating guideline uptake and in the comparative-effectiveness of OPAT versus oral therapy for common conditions such as pneumonia, both of which will be strengthened by the proposed research aims. Aim 1 will compare the use of guideline recommended narrow-spectrum antibiotic therapy for pneumonia between hospitals with and without ASPs in a large network of freestanding children's hospitals as a way to assess their effectiveness in facilitating guideline adoption. Aim 2 will compare clinical outcomes between oral therapy and OPAT for children with complicated pneumonia, a condition where treatment practices are highly variable. Finally, Aim 3 will compare the economic burden, including direct and indirect costs and caregiver quality-of-life, between children treated with oral therapy and OPAT in order to provide a better understanding of the economic and caregiver impact of OPAT. In addition to his research aims, Dr. Hersh has proposed four career development aims including coursework and practical experience in the areas of quality improvement; advanced epidemiologic and biostatistical methods for CER; health economics; and leadership. To complete these aims, Dr. Hersh will have access to strong, established resources. The Department of Pediatrics at the University of Utah and Primary Children's Hospital, operated by Intermountain Healthcare, provide ideal environments for the proposed award including a longstanding history and culture of collaborative scientific investigation in the areas of pediatric respiratory infections, quality improvement, implementation science, and CER. The Department of Pediatrics promotes success of early stage investigators by providing resources dedicated to enhancing access to mentorship and grant support services, including a Pediatric Clinical and Translational Research Scholars Program. The University of Utah has outstanding resources dedicated to mentorship, and early career development and training in biostatistical and epidemiologic methods for CER through the NIH-funded Center for Clinical and Translational Science (CCTS) and the Study Design and Biostatistics Center. Intermountain Healthcare offers the Advanced Training Program, a leading training program for physicians in the science of quality improvement. Dr. Hersh currently has 75% protected time which will be ensured throughout the award period to utilize these resources in achieving his career development goals.

描述（由申请人提供）：拟议的职业发展奖旨在支持博士的过渡。Hersh成为一名独立的医生-科学家，使用比较有效性研究（CER）方法应用于以患者为中心的结局研究（PCOR）议程，致力于提高儿科护理中抗生素使用的适当性，质量和安全性。赫什博士是犹他州大学的儿科传染病专家。他职业发展的下一步是获得CER和卫生经济学的质量改进，流行病学和生物统计方法的高级技能。Hersh博士组建了一个具有跨越这些领域的专业知识的指导和咨询团队。他的AHRQ K08申请提出了3项研究和4项职业发展目标，这些目标将使他成为儿科感染性疾病抗菌药物管理和CER方法领域的领导者。Hersh博士的申请解决了抗生素耐药性日益增长的健康和经济威胁，这在一定程度上是由抗生素过度使用的问题驱动的。抗生素过度使用的两个重要领域包括：（1）使用广谱抗生素，而不是同样有效的窄谱治疗，特别是对于呼吸道感染，如肺炎;（2）使用门诊胃肠外抗生素治疗（OPAT），而不是同样有效，更安全，更便宜的口服治疗。制定和实施抗菌药物管理计划（ASP）是解决这些领域抗生素过度使用的关键策略。然而，儿科ASP受到证据基础薄弱的限制，特别是在促进指南吸收的有效性以及OPAT与口服疗法治疗肺炎等常见疾病的比较有效性方面，这两者都将通过拟议的研究得到加强目标。目标1将比较在一个大型独立儿童医院网络中有和没有ASP的医院之间使用指南推荐的窄谱抗生素治疗肺炎，以评估其在促进指南采用方面的有效性。目的2将比较口服治疗和OPAT治疗儿童复杂性肺炎的临床结果，这种情况下的治疗方法差异很大。最后，目标3将比较口服治疗和OPAT治疗儿童之间的经济负担，包括直接和间接成本以及护理人员的生活质量，以便更好地了解OPAT的经济和护理人员影响。除了他的研究目标，赫什博士还提出了四个职业发展目标，包括质量改进领域的课程和实践经验; CER的先进流行病学和生物统计学方法;卫生经济学;和领导力。为了实现这些目标，赫什博士将获得强大的，既定的资源。犹他州大学儿科系和Intermountain Healthcare运营的Primary Children's Hospital为拟议的奖项提供了理想的环境，包括在儿科呼吸道感染、质量改进、实施科学和CER领域的合作科学调查的悠久历史和文化。儿科系通过提供专门用于加强获得指导和赠款支持服务的资源，包括儿科临床和转化研究学者计划，促进早期研究人员的成功。犹他州大学通过NIH资助的临床和转化科学中心（CCTS）以及研究设计和生物统计学中心，拥有杰出的资源，致力于为CER提供生物统计学和流行病学方法方面的指导、早期职业发展和培训。Intermountain Healthcare提供高级培训计划，这是一个领先的医生质量改进科学培训计划。Hersh博士目前有75%的受保护时间，在整个奖励期间将确保利用这些资源实现他的职业发展目标。