Informatics Approaches to Understand and Reduce Inappropriate Antibiotic Prescribing by Dentists

信息学方法理解和减少牙医不适当的抗生素处方 项目摘要 虽然抗生素（ABx）挽救了许多生命，但其不适当的使用有助于抗菌药物的产生。 阻力过量使用ABx也可能导致过敏反应和不良事件（AE），如 艰难梭菌感染（CDI）。抗生素管理减少了ABx使用对健康的负面影响， 它是由美国牙科协会（ADA）支持的。抗生素预防 在牙科手术之前，应保留给治疗后并发症风险高的患者。尽管 这些建议，在牙科手术前不适当的ABx预防处方是常见的， 70-80%的预防性ABx处方超出指南 我们的小组进行了相关的关键工作，发现牙科在培养 接受研究知情的治疗。我们发现，改善循证牙科治疗的举措 实践的制定和实施往往没有深入了解问题，包括原因 为什么牙医会偏离既定的处方指南。我们的长期目标是建立一个可持续的 国家牙科学习健康系统（LHS）专注于持续的质量改进， 为患者提供高质量、经济实惠、循证的口腔保健。要做到这一点，我们首先需要 建立一个实践层面的LHS，由有效的信息学基础设施、相关的数据治理和信息系统支持。 以及推动循证牙科实践的学习文化。 在这个项目中，我们试图量化和理解指南不一致的抗生素处方， 迭代地制定改进策略，以适当地将处方瞄准具有正确 ABX在正确的时间通过深入了解为什么抗生素如此频繁地被处方以外的 我们期望透过指引，让牙科团队和病人参与制订可行的干预措施。我们将 在两个大型集团实践中进行研究：HealthPartners（HP）和Willamette Dental Group（WDG） 每年总共有超过90万的病人就诊。我们的项目团队由牙科专家组成， 信息学、药理学、医疗质量和安全性以及人为因素。在目标1中，我们开发和 验证基于EHR的算法/质量测量，以确定与当前基于证据的 抗生素处方指南。在目标2中，我们识别和理解与指南相关的因素 通过患者和提供者访谈以及目标诊所，确定抗生素的一致/不一致处方 意见。在目标3中，使用参与式的以人为本的设计过程，我们设计改进 提高与循证ABx指南一致性的策略。我们的研究成果将 用测量和减少不适当ABx的知识和技术来武装牙科领域 由牙医开处方，为我们的患者带来更好的口腔健康，以及随后更好的总体健康。

Informatics Approaches to Understand and Reduce Inappropriate Antibiotic Prescribing by Dentists Project Summary Although antibiotics (ABx) have saved many lives, their inappropriate use contributes to antimicrobial resistance. Overprescribing ABx can also lead to allergic reactions and adverse events (AEs) such as Clostridiodes difficile infection (CDI). Antibiotic stewardship reduces negative health effects of ABx use, thus preserving its future utility and is supported by the American Dental Association (ADA). Antibiotic prophylaxis prior to dental procedures should be reserved for patients at high risk of post-treatment complications. Despite these recommendations, inappropriate ABx prescribing for prophylaxis before dental procedures is common, with 70-80% of prophylactic ABx prescribed outside guidelines Our group has conducted relevant pivotal work and have found that dentistry lags in fostering the uptake of research-informed treatments. We have found that initiatives to improve evidence-based dental practice are often developed and implemented without a deep understanding of the problem, including reasons why dentists deviate from established prescribing guidelines. Our long-term goal is to build a sustainable national dental Learning Health System (LHS) focused on continuous quality improvement that facilitates providing patients with high quality, affordable, evidence-based oral healthcare. To do this, we first need to establish a practice-level LHS supported by an effective informatics infrastructure, relevant data governance and a culture of learning that drives evidence-based dental practice. In this project, we seek to quantify and understand guideline discordant antibiotic prescribing, and to iteratively develop improvement strategies to appropriately target prescribing to the right patients with the right ABx at the right time. Through a deep understanding of why antibiotics are so frequently prescribed outside of the guidelines, we expect to engage the dental team and patients to develop feasible interventions. We will conduct the research at two large group practices: HealthPartners (HP) and Willamette Dental Group (WDG) which together have over 900,000 patient visits per year. Our project team comprises of experts in dental informatics, pharmacology, healthcare quality and safety, and human factors. In Aim 1, we develop and validate an EHR-based algorithm/quality measure to determine concordance with current evidence-based antibiotic prescribing guidelines. In Aim 2, we identify and understand factors associated with guideline concordant/discordant prescribing of antibiotics through patient and provider interviews, and targeted clinic observations. In Aim 3, using a participatory human-centered design process, we design improvement strategies to increase concordance with evidence-based ABx guidelines. The outcomes of our research will arm the dental field with both the knowledge and know-how to measure and reduce inappropriate ABx prescribing by dentists resulting in better oral health, and subsequently better general health, for our patients.