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博士转变为一名独立的内科科学家，使用比较有效性研究(CER)方法，应用于以患者为中心的结果研究(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。赫什博士是犹他大学的儿科传染病专家。他职业发展的下一步是在质量改进、流行病学和CER和卫生经济学的生物统计方法方面获得高级技能。赫什博士组建了一支拥有这些领域专业知识的指导和咨询团队。他的AHRQ K08申请提出了3个研究和4个职业发展目标，这些目标将共同使他成为儿科传染病抗菌管理和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疗法，特别是对肺炎等呼吸道感染；(2)使用门诊非肠道抗生素疗法(OPAT)，而不是同样有效、更安全和成本更低的口服疗法。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问题的关键战略。然而，儿科ASP受到证据基础薄弱的限制，特别是在促进指南采纳方面的有效性以及OPAT与口服疗法对肺炎等常见疾病的比较有效性方面，这两项都将因拟议的研究目标而得到加强。目的1将比较指南推荐的窄谱抗生素治疗肺炎在大型独立儿童医院网络中有无ASP的医院之间的使用情况，以此来评估它们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，在这种情况下，治疗方法是高度可变的。最后，目标3将比较接受口腔治疗和OPAT的儿童之间的经济负担，包括直接和间接费用以及照顾者的生活质量，以便更好地了解OPAT的经济和照顾者影响。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工作和实践经验；CER的先进流行病学和生物统计学方法；卫生经济学；以及领导力。为了实现这些目标，赫什博士将获得强大的、成熟的资源。犹他大学和初级儿童医院的儿科由InterMountain Healthcare运营，为建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领域合作科学研究的悠久历史和文化。儿科系通过提供资源来促进早期研究人员的成功，这些资源专门用于增加获得指导和赠款支持服务的机会，包括儿科临床和转译研究学者计划。犹他大学通过NIH资助的临床和翻译科学中心(CCTS)和研究设计和生物统计中心，拥有卓越的资源，致力于CER的导师、早期职业发展和生物统计学和流行病学方法培训。InterMountain Healthcare提供高级培训计划，这是为医生提供质量改进科学方面的领先培训计划。赫什博士目前有75%的受保护时间，这些时间将在整个获奖期内得到保证，以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.