Optimizing Antibiotic Prescribing on Discharge to Long-term Care Facilities

项目摘要/摘要 在长期护理机构(LTCFs)中，高达75%的抗生素使用是不适当或不必要的。作为回应 由于越来越多的证据表明，从长远来看，与次优抗生素处方相关的不良结果- 在长期护理环境下，医疗保险和医疗补助服务中心(CMS)现在要求LTCFs实施 并将抗菌素管理计划作为参与的条件。面临的一个重大挑战 提高LTCFs的抗生素利用率是40%-50%的LTCFs抗生素使用是在急诊医院开始的 在入院之前。此外，估计70%的出院抗生素处方是 不适当的和患者在出院时给LTCF开抗生素通常缺乏关于 抗生素的适应症、持续时间和培养结果会导致患者的出院总结。 目前，没有专门针对急性护理出院时开抗生素处方的干预措施。 医院到LTCFs。我们的长期目标是改善LTCFs和相关患者的抗生素处方 和居民的结果。在此应用程序中，我们将使用混合方法来开发证据- 针对高价值地区的基础干预捆绑包，优化出院时的抗生素处方 医院到LTCFs。高价值的干预目标将是普遍的、可修改的、与穷人有关的 临床结果，目前没有在标准实践中解决。我们提出了以下具体目标。 具体目标1：确定干预措施的高价值目标，以优化从 医院到LTCFs。我们将进行两项多中心回顾性队列研究：1)以医院为重点的研究 从华盛顿州俄勒冈州的学术、地区和社区医院网络出院的患者， 和威斯康星州，以及2)一项针对俄勒冈州23家LTCFs住院患者的LTCF重点研究， 加利福尼亚州、内华达州和威斯康星州。 具体目标2：确定并描述干预措施的障碍和促进者，以优化抗生素处方 关于从医院到长期合作伙伴关系的过渡。我们将在医院和LTCF之间进行深入的定性访谈 医疗保健提供者、护士和管理员。 具体目标3：制定和完善候选干预措施，以处理#年确定的高价值目标和差距 目标1和目标2。我们将使用与关键医院和LTCF利益相关者的协作流程来完善候选人 并顺序测试干预捆绑包的可接受性。

PROJECT SUMMARY/ABSTRACT Up to 75% of antibiotic use in long-term care facilities (LTCFs) is inappropriate or unnecessary. In response and due to increasing evidence of poor outcomes associated with suboptimal antibiotic prescribing in the long- term care setting, the Centers for Medicare and Medicaid Services (CMS) now require that LTCFs implement and maintain antimicrobial stewardship programs as a condition for participation. A major challenge to improving antibiotic utilization in LTCFs is that 40-50% of LTCF antibiotic use is initiated in acute care hospitals prior to LTCF admission. Furthermore, an estimated 70% of antibiotic prescribing on hospital discharge is inappropriate and patients prescribed antibiotics on discharge to a LTCF often lack information regarding the antibiotic indication, duration, and culture results in patients' discharge summaries. At present, there are no interventions specifically targeting antibiotic prescribing on discharge from acute care hospitals to LTCFs. Our long-term goal is to improve antibiotic prescribing in LTCFs and associated patient and resident outcomes. In this application, we will use a mixed methods approach to develop an evidence- based intervention bundle targeting high-value areas to optimize antibiotic prescribing on discharge from hospitals to LTCFs. High-value targets for intervention will be prevalent, modifiable, associated with poor clinical outcomes, and not currently addressed in standard practice. We propose the following specific aims. Specific Aim 1: Identify high-value targets of interventions to optimize antibiotic prescribing on transition from hospitals to LTCFs. We will conduct two multi-center retrospective cohort studies: 1) a hospital-focused study of patients discharged from a network of academic, regional, and community hospitals in Oregon, Washington, and Wisconsin and 2) a LTCF-focused study of residents admitted from hospitals to 23 LTCFs in Oregon, California, Nevada, and Wisconsin. Specific Aim 2: Identify and describe barriers and facilitators of interventions to optimize antibiotic prescribing on transition from hospitals to LTCFs. We will conduct in-depth qualitative interviews among hospital and LTCF healthcare providers, nurses, and administrators. Specific Aim 3: Develop and refine candidate interventions to address high-value targets and gaps identified in Aims 1 and 2. We will use a collaborative process with key hospital and LTCF stakeholders to refine candidate interventions and sequentially test acceptability of the intervention bundle.