Nurse and Physician Decision-making for Suspected Urinary Tract Infections in Nursing Homes: Potential Targets to Reduce Antibiotic Overuse

疗养院中疑似尿路感染的护士和医生决策：减少抗生素过度使用的潜在目标

• 批准号: 9077477
• 负责人: Christine E Kistler
• 金额: $ 49.74万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-04-01 至 2019-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9077477
• 关键词: Nurse; Physician; Decision; making; Suspected

 DESCRIPTION (provided by applicant): The overuse of antibiotics in infection management has widespread and damaging consequences for human health, including adverse effects and antibiotic resistance. Antibiotic overuse is especially problematic among older adults in nursing homes (NHs), where at any one time over 10% are taking antibiotics and up to 75% of all antibiotic prescriptions likely represent overuse. Clinical decision support systems (CDSS), in which computerized alerts and reminders are provided in real time, appear promising, but to date results in NHs have been lackluster. A key reason for this poor alignment may be the actual decisional processes that underlie prescribing decisions in the NH setting. According to dual process theory, individuals make decisions through both deliberative ways where they weigh different types of information and intuitive ways where they may be misled by non-evidence-based information. Current decision support tools focus on evidence-based information, and the full benefit of CDSS may only be realized once the influence of non-evidenced-based information is taken into account. We propose to conduct a cross-sectional, internet-based, national survey of 1756 providers to identify the most important information, both evidence and non-evidence-based, influencing antibiotic prescribing in NHs. To quantify the relative importance of these different types of information, we will use a discrete choice experiment (DCE). Because most NH prescribing decisions are based on communications between physicians (who are often offsite) and NH-based nurses, the survey will include 878 nurses (examining the information that influences their decisions to communicate with physicians about the potential need for antibiotics) and 878 physicians (who are responsible for prescribing). To evaluate the effect of time pressure on the relative importance of evidence-based and non-evidence-based information, respondents will be divided into high and low time pressure groups. In addition, based on studies demonstrating that personality traits relate to intuitive decision-making, we also explore personality in relation to communication and prescribing decisions. Finally, because there are many circumstances and conditions for which antibiotics are prescribed in NHs, we focus on the most common, namely urinary tract infections (UTI). In summary, the objectives of this proposal are to understand the information most important to (a) nurses' communication about antibiotic-related decisions, and (b) physicians' related antibiotic prescribing decisions for NH residents with suspected UTIs, and the influence of time and personality traits on this information. We believe that knowledge about the way that nurses' and physicians' actually make decisions will provide more accurate targets for improving clinical decision support. The proposed research addresses a national priority and the mission of the Agency for Healthcare Research and Quality with its focus on antibiotic stewardship and infection management in NHs. Our long-term goal is to develop an internet-based clinical decision support system to reduce antibiotic overuse in NHs.

 描述（由适用提供）：感染管理中抗生素过度使用对人类健康的宽度和破坏性后果，包括不良反应和抗生素耐药性。在护士房屋（NHS）的老年人中，抗生素过度使用尤其有问题，在任何一次以上的人使用抗生素，所有抗生素处方中最多可能代表过度使用抗生素。临床决策支持系统（CDSS），在该系统中实时提供计算机化的警报和提醒，表现出承诺，但迄今为止，NHS的结果表现不佳。这种不良对准的一个关键原因可能是在NH环境中规定决定的实际决策过程。根据双重过程理论，个人通过两种审议方式做出决策，在这些方式中，他们权衡了不同类型的信息和直观的方式，而这些信息可能会被基于非证据的信息误导。当前的决策支持工具的重点是基于证据的信息，只有一旦考虑到基于非证实的信息的影响，CDS的全部好处才能实现。我们建议对1756个提供商进行横截面，基于互联网的全国调查，以确定最重要的信息，包括证据和非证据，影响NHS中的抗生素处方。为了量化这些不同类型信息的相对重要性，我们将使用离散选择实验（DCE）。由于大多数NH处方决定是基于医生（通常是异地）和基于NH的护士之间的沟通，因此该调查将包括878名护士（检查影响他们与医生有关抗生素潜在需求的决定的信息）和878名医生（负责处方负责）。为了评估时间压力对基于证据和非证据的信息的相对重要性的影响，受访者将分为高和低时压力组。此外，基于表明人格特征与直观决策有关的研究，我们还探讨了与沟通和开处方决策有关的人格。最后，由于在NHS中开了抗生素的情况和条件很多，因此我们关注最常见的尿路感染（UTI）。总而言之，该提案的目标是了解（a）护士对抗生素相关决策的沟通最重要的信息，以及（b）医生与可疑UTIS的NH居民的相关抗生素规定决策，以及时间和人格性特征对此信息的影响。我们认为，关于护士和医师实际做出决定的知识将为改善临床决策支持提供更准确的目标。拟议的研究旨在解决国家医疗研究和质量机构的任务，其重点是NHS的抗生素管理和感染管理。我们的长期目标是开发一种基于Internet的临床决策支持系统，以减少NHS中过度使用的抗生素。