Using CER to Improve Antibiotic Prescribing and Outcomes in Children

描述（由申请人提供）：拟议的职业发展奖旨在支持Adam L. Hersh博士通过将比较有效性研究（CER）方法应用于以患者为中心的结果研究（PCOR）议程，致力于提高儿科护理中抗生素使用的适宜性、质量和安全性，转变为独立的内科科学家。赫什博士是犹他大学的儿科传染病专家。他的职业发展的下一步是获得质量改进，流行病学和生物统计方法的高级技能，用于CER和卫生经济学。赫什博士组建了一个指导和咨询团队，具有跨越这些领域的专业知识。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传染病抗菌药物管理和CER方法领域的领导者。赫什博士的申请解决了抗生素耐药性日益严重的健康和经济威胁，这在一定程度上是由抗生素过度使用问题造成的。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)使用门诊肠外抗生素治疗（OPAT）代替同样有效、更安全、成本更低的口服治疗。制定和实施抗菌药物管理计划（asp）是解决这些地区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与口服治疗（如肺炎）的比较有效性方面，这两方面都将通过拟议的研究目标得到加强。目的1将比较在一个大型独立儿童医院网络中，有和没有asp的医院对指南推荐的窄谱抗生素治疗肺炎的使用情况，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治疗并发肺炎儿童的临床结果，这是一种治疗方法高度可变的情况。最后，目标3将比较口服治疗和口服药物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，以便更好地了解口服药物治疗对经济和护理人员的影响。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；先进的流行病学和生物统计学方法；卫生经济学;和领导能力。为了完成这些目标，赫什博士将有机会获得强大的既定资源。犹他大学儿科系和Intermountain Healthcare运营的初级儿童医院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领域的长期合作科学研究历史和文化。儿科部门通过提供资源来促进早期研究人员的成功，以增加获得指导和资助支持服务的机会，包括儿科临床和转化研究学者计划。犹他大学通过美国国立卫生研究院资助的临床和转化科学中心（CCTS）和研究设计和生物统计中心，拥有优秀的资源，致力于指导、早期职业发展和培训CER的生物统计和流行病学方法。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。赫什博士目前有75%的保护时间，这将确保在整个奖励期间利用这些资源实现他的职业发展目标。

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.