Standardizing Antibiotic Prescribing for Children Hospitalized with Infections using Novel Metrics and Electronic Clinical Decision Support Tools

项目总结/摘要 抗生素是儿童最常用的处方药之一，但30-50%的抗生素是 不适当的规定或完全不必要的。尽管有国家认可的治疗方法 指南和抗菌药物管理计划的扩展，偏离循证实践 增加了处方的可变性。个别供应商的特点，包括知识赤字， 已知导致抗生素选择的变异性。然而，其他因素，包括可用性 规定资源、当地文化、社会压力和工作环境也可能导致这一点 变化，但受到的关注较少。对抗生素处方来源的丰富理解 一线供应商之间的可变性可以通知可用性和工作流程集成，以最大限度地提高 处方干预。由于移动的电子临床决策支持（eCDS）工具具有潜力， 接触广泛的受众并整合最终用户（即，一线开处方者）和用户环境（即， 忙碌的住院病房），它们可能成为传播循证抗生素的有力工具 实践Markham博士是一名儿科住院医师，也是这一职业发展奖的候选人， 与强大的跨学科导师团队一起制定了一个5年职业发展计划， 包括结构化的指导，完成人因科学的培训和定性分析的应用。 系统分析、实施科学和临床信息学中的方法。这种独特的组合， 培训活动与Markham博士的临床专业知识相结合，将使Markham博士处于以下领域的最前沿： eCDS工具在儿科的应用。获得这些技能将为马卡姆博士建立一条途径， 通过发展和加强医疗保健服务， 实施新的eCDS工具和针对影响儿童的其他高度优先诊断的干预措施。 博士万锦的培训活动将得到一个创新项目的补充， 运用这些新技能。该项目的目标是：（1）测量和了解内部和内部的， 医院抗生素处方变异性为住院儿童常见感染;（2）利用可用性 测试和心理测量分析，以评估eCDS工具对提供循证抗生素的影响 在模拟情景中提出建议;以及（3）进行试点实施研究，以探索障碍 和促进者，以大规模部署可用性知情的抗生素eCDS工具。从这个研究结果 将用于确定需要标准化治疗的感染的优先顺序，跟踪抗生素标准化 随着时间的推移不断改进，并为未来的实施研究提供信息，研究eCDS工具对 抗生素使用标准化和患者结局。该提案的最终目标是提供博士。 Markham拥有通过提高准确性和效率来有效增强医疗保健系统的技能 医疗保健专业人员可以为儿童提供高质量的循证护理。

PROJECT SUMMARY/ABSTRACT Antibiotics are one of the most prescribed classes of medications for children, yet 30-50% of all antibiotics are inappropriately prescribed or completely unnecessary. Despite the availability of nationally endorsed treatment guidelines and the expansion of antimicrobial stewardship programs, deviation from evidence-based practices occurs adding to prescribing variability. Individual provider characteristics including knowledge deficits are known to contribute to variability in antibiotic selection. However, other factors, including usability of available prescribing resources, local culture, social pressures, and the work environment likely also contribute to this variation, but have received less attention. Developing a rich understanding of sources of antibiotic prescribing variability among front-line providers can inform usability and workflow integration to maximize uptake of prescribing interventions. As mobile electronic clinical decision support (eCDS) tools have the potential to reach broad audiences and to integrate the end-users (i.e., front-line prescribers) and user environment (i.e., busy inpatient ward) they may serve as powerful tools in the dissemination of evidence-based antibiotic practices. Dr. Markham, a pediatric hospitalist physician and the candidate for this Career Development Award, together with a strong interdisciplinary mentorship team has created a 5-year career development plan which includes structured mentoring, completion of training in human factors science and the application of qualitative methods within systems analyses, implementation science, and clinical informatics. This unique combination of training activities in combination with Dr. Markham’s clinical expertise will place Dr. Markham at the forefront of eCDS tool implementation in pediatrics. Acquisition of these skills will establish a pathway for Dr. Markham to become a leader in addressing the quality and safety of pediatric hospitalizations through the development and implementation of novel eCDS tools and interventions targeting other high-priority diagnoses affecting children. Dr. Markham's training activities will be complemented by an innovative project that will facilitate practical application of these new skills. The goals of the project are to: (1) measure and understand inter- and intra- hospital antibiotic prescribing variability for children hospitalized with common infections; (2) utilize usability testing and psychometric analysis to evaluate the impact of an eCDS tool to deliver evidence-based antibiotic recommendations within simulated scenarios; and (3) perform a pilot implementation study to explore barriers and facilitators to widescale deployment of a usability informed antibiotic eCDS tool. Findings from this study will be used to prioritize infections in need of standardization of treatment, to track antibiotic standardization improvement over time, and to inform future implementation studies examining the impact of eCDS tools on standardization of antibiotic use and patient outcomes. The ultimate goal of this proposal is to provide Dr. Markham with the skills to effectively enhance healthcare systems by improving the accuracy and efficiency with which healthcare professionals can provide high-quality, evidence-based care to children.