Demonstration of Near Zero Antibiotic Prescribing for Acute Bronchitis

背景：研究表明，指南声明和性能测量断言抗菌剂 给无并发症的急性支气管炎开处方是不合适的。然而，临床医生开出的处方 在美国每年2250万急性支气管炎就诊者中，超过60%的人服用了抗菌药。 以前成功的干预措施，虽然在流行病学上是严格的，但只减少了抗菌素 处方率为40%或50%。目前尚不清楚急性支气管炎的抗菌药处方率是否可以 在保持患者安全和满意度的同时，在实际操作中使其接近于零。 研究计划：本项目的具体目标1是开发一种适用于 减少抗菌药物治疗成人急性支气管炎 处方率降至接近零。具体目标2是执行受控的、持续监测的、 大型急性支气管炎EHR综合诊疗算法的实现， 多样化的初级保健实践。我们将使用多模式实施-包括计算机化 决策支持、报告工具和临床医生反馈-以及质量改进技术，以确保 坚持算法，并将抗菌处方率降至接近零的水平。这个 主要结果将是急性支气管炎患者的抗菌药处方率。次要的 结果将包括患者症状、患者满意度、患者安全和医疗成本。至 确保未来算法的有效传播和干预，一个主要成果将是 获取和描述对抗菌药物处方影响最大的成分 费率。具体目标2a是开发与EHR无关的算法和实现版本 在没有EHR的诊所中使用的方法。具体目标3是传播算法和 在11个诊所初级保健实践研究网络中的实施方法和 将急性支气管炎的抗菌药处方率降至接近零的水平。 未来的方向和影响：在未来，我们计划广泛传播并继续测试 算法的EHR依赖版本和EHR独立版本的有效性和安全性 实现方法。有效算法的开发、演示和广泛传播 将急性支气管炎的抗菌药处方减少到接近零的水平有可能减少 美国的不良药物事件、医疗费用和抗菌素耐药性细菌的流行率 各州。该项目还将检查各种改变非卧床的工具的有效性 可以推广到其他临床情况的做法。

Background: Studies show, guidelines state, and performance measures assert that antimicrobial prescribing for uncomplicated acute bronchitis is inappropriate. However, clinicians prescribe antimicrobials in over 60% of the 22.5 million acute bronchitis visits in the United States each year. Previous successful interventions, while epidemiologically rigorous, have only reduced the antimicrobial prescribing rate to 40% or 50%. It is unknown if the antimicrobial prescribing rate for acute bronchitis can be brought to near zero percent in actual practice while maintaining patient safety and satisfaction. Research Plan: Specific Aim 1 of this project is to develop an EHR-integrated algorithm for the diagnosis and treatment of adults with acute bronchitis with a goal of reducing the antimicrobial prescribing rate to near zero percent. Specific Aim 2 is to perform a controlled, continuously-monitored, implementation of an EHR-integrated diagnosis and treatment algorithm for acute bronchitis in a large, diverse primary care practice. We will use a multi-modal implementation - including computerized decision support, reporting tools, and clinician feedback - and quality improvement techniques to ensure adherence to the algorithm and reduce the antimicrobial prescribing rate to near zero percent. The primary outcome will be the antimicrobial prescribing rate for patients with acute bronchitis. Secondary outcomes will include patient symptoms, patient satisfaction, patient safety, and healthcare costs. To ensure the effective future dissemination of the algorithm and intervention, a major outcome will be the capture and description of the components that had the greatest effect on the antimicrobial prescribing rate. Specific Aim 2a is to develop an EHR-independent version of the algorithm and implementation method for use in clinics that do not have EHRs. Specific Aim 3 is to disseminate the algorithm and implementation method throughout an 11-clinic Primary Care Practice-Based Research Network and reduce the antimicrobial prescribing rate for acute bronchitis to near zero percent. Future Directions and Implications: In the future, we plan to broadly disseminate and continue to test the effectiveness and safety of the EHR-dependent and EHR-independent versions of the algorithm and implementation method. Development, demonstration, and broad dissemination of an effective algorithm to reduce antimicrobial prescribing to near zero percent for acute bronchitis has the potential to decrease adverse drug events, healthcare costs, and the prevalence of antimicrobial resistant bacteria in the United states. This project will also examine the effectiveness of a variety of tools for changing ambulatory practice that can generalize to other clinical conditions.