Demonstration of Near Zero Antibiotic Prescribing for Acute Bronchitis

背景：研究表明，指南指出，性能指标断言， 不适用于无并发症的急性支气管炎。然而，临床医生规定， 在美国，每年2250万急性支气管炎患者中有超过60%使用抗菌药物。 以前成功的干预措施，虽然流行病学上严格，但只减少了抗菌药物， 处方率降至40%或50%。目前尚不清楚急性支气管炎的抗菌药物处方率是否可以 在实际操作中接近于零，同时保持患者的安全和满意度。 研究计划：本项目的具体目标1是开发一种EHR集成算法， 诊断和治疗成人急性支气管炎的目的是减少抗菌药物 处方率接近于零。具体目标2是执行一个受控的，持续监测的， 急性支气管炎EHR集成诊断和治疗算法在大型， 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 遵守该算法，并将抗菌药物处方率降至接近零。的 主要结果将是急性支气管炎患者的抗菌药物处方率。二次 结果将包括患者症状、患者满意度、患者安全和医疗保健成本。到 为了确保算法和干预措施在未来的有效传播，一个主要成果将是 收集和描述对抗菌药物处方影响最大的组分 率具体目标2a是开发EHR独立版本的算法和实现 在没有EHR的诊所使用的方法。具体目标3是传播算法， 在11个诊所的基于初级保健实践的研究网络中的实施方法， 将急性支气管炎的抗菌药物处方率降至接近零。 今后的方向和意义：今后，我们计划广泛传播，并继续测试 EHR依赖和EHR独立版本算法的有效性和安全性，以及 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物处方减少到接近零， 不良药物事件、医疗费用和美国抗菌素耐药菌的患病率 states.该项目还将研究各种工具的有效性，以改变门诊 实践，可以推广到其他临床条件。

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.