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

项目摘要/摘要 抗生素是儿童最常用的药物之一，但30%-50%的抗生素是 不适当的处方或者完全没有必要。尽管有国家认可的治疗方法 指导方针和抗菌素管理方案的扩展，偏离循证做法 增加了处方的可变性。个别提供者的特征包括知识缺陷 已知会导致抗生素选择的变异性。然而，其他因素，包括可用的可用性 处方资源、当地文化、社会压力和工作环境可能也是造成这种情况的原因 变化，但受到的关注较少。加深对抗生素处方来源的理解 一线提供商之间的差异可以为可用性和工作流集成提供信息，以最大限度地利用 开出干预处方。由于移动电子临床决策支持(ECDS)工具具有以下潜力 覆盖广大受众，并将最终用户(即一线处方医生)和用户环境(即， 繁忙的住院区)他们可能成为传播循证抗生素的有力工具 练习。马卡姆医生是一名儿科住院医师，也是本届职业发展奖的候选人， 与强大的跨学科导师团队一起，制定了为期5年的职业发展计划， 包括结构化指导、完成人因科学方面的培训和应用定性 方法系统分析、实施科学和临床信息学。这一独特的组合 培训活动与马卡姆博士的临床专业知识相结合，将使马卡姆博士处于 儿科ECDS工具的实施。获得这些技能将为马卡姆博士建立一条途径 成为解决儿科住院质量和安全问题的领导者，通过发展和 针对影响儿童的其他高度优先的诊断，实施新的电子传染病工具和干预措施。 Markham博士的培训活动将得到一个创新项目的补充，该项目将促进实际 这些新技能的应用。该项目的目标是：(1)测量和了解内部和内部 常见感染住院儿童医院抗生素处方的可变性；(2)利用易用性 评估ECDS工具提供循证抗生素的影响的测试和心理测量分析 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 以及广泛部署可用性知情的抗生素ECDS工具的促进者。这项研究的发现 将用于对需要标准化治疗的感染进行优先排序，以跟踪抗生素标准化 随着时间的推移不断改进，并为未来的实施研究提供信息，审查电子疾控工具对以下方面的影响 抗生素使用和患者结果的标准化。这项提案的最终目标是为Dr。 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 有了它，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.