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（由申请人提供）：在感染管理中过度使用抗生素会对人类健康产生广泛的破坏性后果，包括不良影响和抗生素耐药性，这对于疗养院（NH）的老年人来说尤其成问题，因为在任何时候。超过 10% 的人正在服用抗生​​素，而高达 75% 的抗生素处方可能代表过度使用，其中实时提供计算机警报和提醒，这看起来很有希望，但迄今为止的结果。 NH 中的这种一致性不佳的一个关键原因可能是 NH 环境中处方决策的实际决策过程，个人通过权衡不同类型的信息和直觉来做出决策。当前的决策支持工具侧重于基于证据的信息，只有考虑到基于证据的信息的影响，才能实现 CDSS 的全部好处。我们建议对 1756 家提供者进行一项基于互联网的横断面全国调查，以确定影响 NH 抗生素处方的最重要信息（包括证据和非证据），以量化这些不同类型的相对重要性。由于大多数 NH 处方决策是基于医生（通常不在现场）和 NH 护士之间的沟通，因此我们将使用离散选择实验 (DCE)，因此该调查将包括 878 名护士（检查影响他们的信息）。与医生就抗生素的潜在需求进行沟通的决定）和 878 名医生（负责处方）为了评估时间压力对循证和非循证信息相对重要性的影响，受访者将被分成不同的部分。此外，根据研究表明人格特征与直觉决策相关，我们还探讨了与沟通和处方决策相关的人格。最后，因为抗生素适用于许多情况和条件。 NH 中规定，我们重点关注最常见的疾病，即尿路感染 (UTI)。 总之，本提案的目标是了解对 (a) 护士关于抗生素相关决策的沟通和 (b) 医生相关抗生素最重要的信息。为疑似尿路感染的 NH 居民制定处方，以及时间和性格特征对这些信息的影响。我们相信，了解护士和医生实际决策的方式将为改善临床决策支持提供更准确的目标。研究涉及国家优先事项和使命医疗保健研究和质量机构，重点关注 NH 中的抗生素管理和感染管理。我们的长期目标是开发基于互联网的临床决策支持系统，以减少 NH 中的抗生素过度使用。