Using CER to Improve Antibiotic Prescribing and Outcomes in Children

利用 CER 改善儿童抗生素处方和治疗效果

• 批准号: 9114045
• 负责人: Adam L. Hersh
• 金额: $ 16.02万
• 依托单位: UNIVERSITY OF UTAH
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-08-01 至 2019-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9114045
• 关键词: Using; CER; Improve; Antibiotic; Prescribing

DESCRIPTION (provided by applicant): The proposed career development award is designed to support the transition of Dr. Adam L. Hersh into an independent physician-scientist using comparative-effectiveness research (CER) methods applied to a patient- centered outcomes research (PCOR) agenda that is dedicated to improving the appropriateness, quality, and safety of antibiotic use of in pediatric care. Dr. Hersh is a pediatric infectious diseases specialist at he University of Utah. The next steps in his career development are to gain advanced skills in quality improvement, epidemiologic, and biostatistical methods for CER and health economics. Dr. Hersh has assembled a mentoring and advisory team with expertise that spans these areas. His AHRQ K08 application proposes 3 research and 4 career development aims that will collectively enable him to become a leader in the areas of antimicrobial stewardship and CER methods in pediatric infectious diseases. Dr. Hersh's application addresses the growing health and economic threat of antibiotic resistance, which is driven in part by the problem of antibiotic overuse. Two important areas of antibiotic overuse include (1) the use of broad-spectrum antibiotics instead of equally effective narrow- spectrum therapy, especially for respiratory infections such as pneumonia; and (2) the use of outpatient parenteral antibiotic therapy (OPAT) instead of equally effective, safer, and less costly oral therapy. The development and implementation of antimicrobial stewardship programs (ASPs) are key strategies to address antibiotic overuse in these areas. However, pediatric ASPs are limited by a weak evidence-base, particularly pertaining to their effectiveness in facilitating guideline uptake and in the comparative-effectiveness of OPAT versus oral therapy for common conditions such as pneumonia, both of which will be strengthened by the proposed research aims. Aim 1 will compare the use of guideline recommended narrow-spectrum antibiotic therapy for pneumonia between hospitals with and without ASPs in a large network of freestanding children's hospitals as a way to assess their effectiveness in facilitating guideline adoption. Aim 2 will compare clinical outcomes between oral therapy and OPAT for children with complicated pneumonia, a condition where treatment practices are highly variable. Finally, Aim 3 will compare the economic burden, including direct and indirect costs and caregiver quality-of-life, between children treated with oral therapy and OPAT in order to provide a better understanding of the economic and caregiver impact of OPAT. In addition to his research aims, Dr. Hersh has proposed four career development aims including coursework and practical experience in the areas of quality improvement; advanced epidemiologic and biostatistical methods for CER; health economics; and leadership. To complete these aims, Dr. Hersh will have access to strong, established resources. The Department of Pediatrics at the University of Utah and Primary Children's Hospital, operated by Intermountain Healthcare, provide ideal environments for the proposed award including a longstanding history and culture of collaborative scientific investigation in the areas of pediatric respiratory infections, quality improvement, implementation science, and CER. The Department of Pediatrics promotes success of early stage investigators by providing resources dedicated to enhancing access to mentorship and grant support services, including a Pediatric Clinical and Translational Research Scholars Program. The University of Utah has outstanding resources dedicated to mentorship, and early career development and training in biostatistical and epidemiologic methods for CER through the NIH-funded Center for Clinical and Translational Science (CCTS) and the Study Design and Biostatistics Center. Intermountain Healthcare offers the Advanced Training Program, a leading training program for physicians in the science of quality improvement. Dr. Hersh currently has 75% protected time which will be ensured throughout the award period to utilize these resources in achieving his career development goals.

描述（由申请人提供）：拟议的职业发展奖旨在支持Adam L. Hersh博士的过渡到独立的医师科学家，使用比较效能研究（CER）方法适用于患者以患者为中心的结果（PCOR）议程，该方法致力于改善适应性，质量，质量，替代性使用的替代性。 Hersh博士是犹他大学的儿科传染病专家。他职业发展的下一步是获得CER和健康经济学的质量改进，流行病学和生物统计学方法的高级技能。 Hersh博士以跨越这些领域的专业知识组装了一个指导和咨询团队。他的AHRQ K08申请提出了3项研究和4个职业发展的目标，这将使他能够成为小儿传染病抗菌管理和CER方法领域的领导者。 HERSH博士的应用涉及抗生素耐药性的健康和经济威胁，部分原因是抗生素过度使用问题。抗生素过度使用的两个重要领域包括（1）使用宽光谱抗生素而不是同样有效的窄光谱疗法，尤其是对于肺炎等呼吸道感染； （2）使用门诊肠胃外抗生素治疗（OPAT），而不是同样有效，更安全，更昂贵的口服疗法。抗菌管理计划（ASP）的开发和实施是解决这些领域抗生素过度使用的关键策略。然而，小儿ASP受到较弱的证据库的限制，尤其是与它们在促进准则吸收的有效性以及对肺炎等常见状况的OPAT与口服疗法的比较效果有关的限制，这两种疾病都将由拟议的研究目标增强。 AIM 1将比较指南建议在大型独立儿童医院网络中使用和没有ASP的医院之间对肺炎进行狭窄的抗生素疗法，以评估其在促进指南采用方面的有效性。 AIM 2将比较复杂性肺炎儿童口腔疗法和OPAT之间的临床结果，这种情况是治疗方法高度可变的疾病。最后，AIM 3将比较接受口腔疗法和OPAT治疗的儿童之间的经济负担，包括直接和间接成本以及护理人员生活质量，以便更好地了解OPAT的经济和照顾者影响。除了他的研究目的外，Hersh博士还提出了四个职业发展目标，包括课程和在质量提高领域的实践经验； CER的晚期流行病学和生物统计学方法；卫生经济学；和领导。为了完成这些目标，Hersh博士将获得强大的，建立的资源。由Intermountain Healthcare运营的犹他大学和小学儿童医院的儿科系为拟议奖励提供理想的环境，包括在小儿呼吸道感染，质量改善，实施科学和CER领域的长期历史和合作科学研究文化。儿科系通过提供致力于增强获得指导和授予支持服务的资源（包括儿科临床和转化研究学者计划）来促进早期研究人员的成功。犹他大学拥有致力于指导的杰出资源，以及通过NIH资助的临床和转化科学中心（CCTS）以及研究设计和生物统计学中心，用于CER的生物统计学和流行病学方法的早期职业发展和培训。 Intermountain Healthcare提供了高级培训计划，这是一项针对质量改进科学的医师的领先培训计划。 HERSH博士目前有75％的保护时间，可以在整个奖项期间确保利用这些资源来实现其职业发展目标。