Using Large Observational Datasets to Improve Antibiotic Prescribing for Community-Acquired Pneumonia

项目摘要 德什潘德博士是医学研究所基于价值的护理研究中心的初级教员， 克利夫兰诊所内科和传染病科的助理工作人员，以及 凯斯西保留地克利夫兰诊所勒纳医学院医学助理教授 大学，俄亥俄州克利夫兰。这个职业发展奖的目标是提供健康服务方面的培训。 研究，包括指导应用严格的研究方法，以确定有效的诊断和 CAP患者的治疗策略。通过他目前的项目，他将增加我们对 CAP的抗菌治疗。未来的项目将把这些发现应用于设计有助于 临床医生会做出更好的抗生素选择。他的长期目标是成为一名领先的临床研究人员 开展传染病方面的卫生服务研究。 尽管这是美国住院的主要原因之一，但仍有许多问题没有得到解答 关于CAP的最佳诊断和治疗。CAP仍然是住院的主要原因 以及美国的死亡。全国范围内不断增长的抗菌素耐药性进一步复杂化了选择 一个适当的初始治疗方案。医生必须确保CAP患者对其产生耐药性 微生物得到适当的治疗，同时最大限度地减少广谱抗生素的过度使用。鉴于其 巨大的影响和日益普遍的抗生素耐药性迫切需要研究 工作重点是确定不断变化的微生物病原学和CAP抗菌剂的最佳做法 心理治疗。 在这个职业发展奖中，Deshpande博士建议研究3个问题，并在这样做的过程中获得 新的研究方法和处理3个不同大数据集的经验。问题如下：1) 目前美国CAP的流行病学和耐药性模式是什么？2)什么是 局部抗生素耐药模式、医生处方和患者预后之间的关系？和3) 早期从静脉注射到口服抗生素治疗是否减少了住院时间(LOS)并降低了成本 治疗失败或重新入院的人数增加。 拟议的职业发展计划包括传染病流行病学方面的高级培训， 比较有效性和大型数据库队列研究，以及密切指导的研究。他的非常 强大的指导团队由Rothberg博士领导，他是一位知名的成果研究员，对 医疗保健与肺炎相关，并通过联邦资金提供支持。 拟议的一系列调查，使用来自3个大型数据库的丰富数据集，将产生 有关CAP管理实践和相关患者结局的重要新知识。这项研究 直接涉及到奥巴马总统最近的倡议：“抗击抗生素耐药性的国家战略” 细菌“。

Project Summary Dr. Deshpande is a junior faculty member at the Medicine Institute Center for Value-Based Care Research, Assistant Staff in the Departments of Internal Medicine and Infectious Diseases at Cleveland Clinic, and an Assistant Professor of Medicine at the Cleveland Clinic Lerner College of Medicine at Case Western Reserve University, Cleveland, OH. The goal of this career development award is to provide training in health services research, including mentored application of rigorous research methods to identify effective diagnostic and treatment strategies for patients with CAP. Through his current project, he will add to our understanding of antimicrobial therapy for CAP. Future projects will apply these findings to design interventions that help clinicians make better antibiotic choices. His long term goal is to become a leading clinical researcher performing health services research in infectious diseases. Despite being one of the leading causes of hospitalization in the US, there remain many unanswered questions regarding the optimal diagnosis and treatment of CAP. CAP continues to be a leading cause of hospitalization and death in the United States. Growing antimicrobial resistance nationally further complicates the selection of an appropriate initial therapeutic regimen. Physicians must ensure that patients with CAP caused by resistant organisms receive appropriate treatment, while minimizing overuse of broad-spectrum antibiotics. Given its enormous impact and the increasing prevalence of antibiotic resistance there is a critical need for research efforts focused on identifying the changing microbial etiology and the best practices for CAP antimicrobial therapy. In this career development award, Dr. Deshpande proposes to study 3 questions and in so doing will acquire new research methods and experience working with 3 distinct large datasets. The questions are as follows: 1) What are the current epidemiology and antibiotic resistance patterns of CAP in the US? 2) What is the relationship between local antibiotic resistance patterns, physician prescribing and patient outcomes? And 3) Does early switch therapy from intravenous to oral antibiotics reduce length of stay (LOS) and cost without increasing treatment failure or readmissions. The proposed career development plan incorporates advanced training in infectious disease epidemiology, comparative effectiveness and large database cohort studies, as well as closely mentored research. His very strong mentorship team is led by Dr. Rothberg, who is an established outcomes researcher with an interest in healthcare associated pneumonia and supported through federal funding. The proposed series of investigations, using a rich dataset derived from 3 large databases, will generate important new knowledge about CAP management practices and associated patient outcomes. The research speaks directly to President Obama’s recent initiative: “National Strategy for Combating Antibiotic-Resistant Bacteria”.