National Healthcare Quality and Disparities Report
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AHRQ Research Studies Date
Topics
- Adverse Events (1)
- Antibiotics (14)
- (-) Antimicrobial Stewardship (16)
- Caregiving (1)
- Children/Adolescents (3)
- Critical Care (1)
- Dental and Oral Health (1)
- Education: Patient and Caregiver (1)
- Elderly (1)
- Emergency Department (1)
- Guidelines (1)
- Healthcare-Associated Infections (HAIs) (4)
- Healthcare Cost and Utilization Project (HCUP) (2)
- Healthcare Costs (2)
- Health Information Technology (HIT) (1)
- Health Literacy (1)
- Home Healthcare (1)
- Hospitalization (3)
- Hospitals (2)
- Infectious Diseases (2)
- Intensive Care Unit (ICU) (1)
- Long-Term Care (1)
- Medication (13)
- Methicillin-Resistant Staphylococcus aureus (MRSA) (1)
- Mortality (2)
- Nursing (1)
- Nursing Homes (1)
- Patient Safety (5)
- Practice Patterns (2)
- Prevention (1)
- Quality Improvement (1)
- Quality of Care (1)
- Respiratory Conditions (2)
- Sepsis (3)
- Shared Decision Making (1)
- Transitions of Care (1)
AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 16 of 16 Research Studies DisplayedRIchmond J, Mangrum R, Wang G
An informed public's views on reducing antibiotic overuse.
The purpose of this study was to understand public attitudes about and recommendations to address antibiotic overuse by employing public deliberation (a method for eliciting informed input on value-laden issues). The investigators concluded that when informed about individual and social consequences of antibiotic overuse, patients may be more receptive to antibiotic prescription limits. They suggest that community-physician-government partnerships are needed to create solutions.
AHRQ-funded; 290201000005C.
Citation: RIchmond J, Mangrum R, Wang G .
An informed public's views on reducing antibiotic overuse.
Health Serv Res 2019 Dec;54(6):1283-94. doi: 10.1111/1475-6773.13175..
Keywords: Antimicrobial Stewardship, Antibiotics, Medication, Health Literacy, Education: Patient and Caregiver
Chiotos K, Rock C, Schweizer ML
Current infection prevention and antibiotic stewardship program practices: a survey of the Society for Healthcare Epidemiology of America (SHEA) Research Network (SRN).
This survey compares results with a similar 2013 survey that characterizes contemporary infection prevention and antibiotic stewardship program practices across 64 healthcare facilities. There was decreased frequency of active surveillance for MRSA, frequent active surveillance for carbapenem-resistant Enterobacteriaceae, and increased support for antibiotic stewardship programs.
AHRQ-funded; HS026393.
Citation: Chiotos K, Rock C, Schweizer ML .
Current infection prevention and antibiotic stewardship program practices: a survey of the Society for Healthcare Epidemiology of America (SHEA) Research Network (SRN).
Infect Control Hosp Epidemiol 2019 Sep;40(9):1046-49. doi: 10.1017/ice.2019.172.
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Keywords: Antimicrobial Stewardship, Antibiotics, Medication, Methicillin-Resistant Staphylococcus aureus (MRSA), Healthcare-Associated Infections (HAIs), Infectious Diseases, Prevention, Practice Patterns
Goldstein E, Olesen SW, Karaca Z
AHRQ Author: Karaca Z
Levels of outpatient prescribing for four major antibiotic classes and rates of septicemia hospitalization in adults in different US states - a statistical analysis.
The authors related state-specific rates of outpatient prescribing overall for oral fluoroquinolones, penicillins, macrolides, and cephalosporins between 2011 and 2012 to state-specific rates of septicemia hospitalization in several age groups of adults. They found positive associations between the rates of prescribing for penicillins and the rates of hospitalization with septicemia in US adults aged 50-84 years and recommended further studies.
AHRQ-authored.
Citation: Goldstein E, Olesen SW, Karaca Z .
Levels of outpatient prescribing for four major antibiotic classes and rates of septicemia hospitalization in adults in different US states - a statistical analysis.
BMC Public Health 2019 Aug 19;19(1):1138. doi: 10.1186/s12889-019-7431-8..
Keywords: Healthcare Cost and Utilization Project (HCUP), Antibiotics, Antimicrobial Stewardship, Sepsis, Medication, Hospitalization
Anderson DJ, Watson S, Moehring RW
Feasibility of core antimicrobial stewardship interventions in community hospitals.
The purpose of this study was to determine the feasibility and results of implementing 2 core stewardship intervention strategies in community hospitals. The two antimicrobial stewardship strategies targeted vancomycin hydrochloride, piperacillin-tazobactam, and the antipseudomonal carbapenems on formulary at the study hospitals: (1) modified preauthorization (PA), in which the prescriber had to receive pharmacist approval for continued use of the antibiotic after the first dose, and (2) postprescription audit and review (PPR), in which the pharmacist would engage the prescriber about antibiotic appropriateness after 72 hours of therapy.
AHRQ-funded; HS023866.
Citation: Anderson DJ, Watson S, Moehring RW .
Feasibility of core antimicrobial stewardship interventions in community hospitals.
The purpose of this study was to determine the feasibility and results of implementing 2 core stewardship intervention strategies in community hospitals. The two antimicrobial stewardship strategies targeted vancomycin hydrochloride, piperacillin-tazobactam, and the antipseudomonal carbapenems on formulary at the study hospitals: (1) modified preauthorization (PA), in which the prescriber had to receive pharmacist approval for continued use of the antibiotic after the first dose, and (2) postprescription audit and review (PPR), in which the pharmacist would engage the prescriber about antibiotic appropriateness after 72 hours of therapy..
Keywords: Antibiotics, Antimicrobial Stewardship, Healthcare-Associated Infections (HAIs), Hospitals, Infectious Diseases, Medication, Patient Safety
Dyer AP, Dodds Ashley E, Anderson DJ
Total duration of antimicrobial therapy resulting from inpatient hospitalization.
The purpose of this study was to assess the feasibility of electronic data capture of post-discharge durations and evaluate total durations of antimicrobial exposure related to inpatient hospital stays. Results showed that discharge antimicrobial therapy accounted for a large portion of antimicrobial exposure related to inpatient hospital stays and suggested that discharge prescription data can be feasibly captured through electronic prescribing records and may aid in designing stewardship interventions at transitions of care.
AHRQ-funded; HS023866.
Citation: Dyer AP, Dodds Ashley E, Anderson DJ .
Total duration of antimicrobial therapy resulting from inpatient hospitalization.
Infect Control Hosp Epidemiol 2019 Aug;40(8):847-54. doi: 10.1017/ice.2019.118..
Keywords: Antimicrobial Stewardship, Health Information Technology (HIT), Hospitalization, Patient Safety, Transitions of Care
Weinberger J, Rhee C, Klompas M
A critical analysis of the literature on time-to-antibiotics in suspected sepsis.
The Surviving Sepsis Campaign recommends immediate antibiotics for all patients with suspected sepsis and septic shock, ideally within 1 hour of recognition. An accurate understanding of the precise relationship between time-to-antibiotics and mortality for patients with possible sepsis is therefore critical. In this study, the investigators elaborate on potential sources of bias and try to distill a better understanding of what the true relationship between time-to-antibiotics and mortality may be for patients with suspected sepsis or septic shock.
AHRQ-funded; HS025008.
Citation: Weinberger J, Rhee C, Klompas M .
A critical analysis of the literature on time-to-antibiotics in suspected sepsis.
J Infect Dis 2020 Jul 21;222(Suppl 2):S110-s18. doi: 10.1093/infdis/jiaa146..
Keywords: Sepsis, Antibiotics, Medication, Antimicrobial Stewardship, Quality Improvement, Quality of Care, Mortality
Tandan M, Sloane PD, Ward K
Antimicrobial resistance patterns of urine culture specimens from 27 nursing homes: impact of a two-year antimicrobial stewardship intervention.
This study evaluated the impact of a two-year antimicrobial stewardship intervention program at 27 nursing homes. The objective was to identify changes in the prevalence and antimicrobial resistance patterns of potentially pathogenic bacteria in urine cultures. All urine cultures were audited during the time period, and out of 6,718 total urine cultures collected, 68% were positive for potentially antimicrobial resistant bacteria. Most of the bacteria identified were E. coli, Proteus spp, and Klebsiella pneumonia. During the 2-year program there was a significant decrease in nitrofurantoin resistance among E. coli and ciprofloxacin resistant among Proteus spp, but carbanepem resistance increased for Proteus spp. Overall, while there was some reduction in antibiotic resistance, the reductions were too small and scattered to conclude the intervention made a big impact.
AHRQ-funded; HS022846.
Citation: Tandan M, Sloane PD, Ward K .
Antimicrobial resistance patterns of urine culture specimens from 27 nursing homes: impact of a two-year antimicrobial stewardship intervention.
Infect Control Hosp Epidemiol 2019 Jul;40(7):780-86. doi: 10.1017/ice.2019.108..
Keywords: Antibiotics, Antimicrobial Stewardship, Elderly, Long-Term Care, Medication, Nursing Homes
Goldstein E, MacFadden DR, Karaca Z
AHRQ Author: Karaca Z Steiner CA
Antimicrobial resistance prevalence, rates of hospitalization with septicemia and rates of mortality with sepsis in adults in different US states.
Researchers studied the relation between the prevalence of resistance to various antibiotics in different bacteria and rates of sepsis-related outcomes. They found that, among the different combinations of antibiotics/bacteria, prevalence of resistance to fluoroquinolones in E. coli had the strongest association with septicemia hospitalization rates for individuals aged over 50 years, and with sepsis mortality rates for individuals aged 18-84 years. They also found a number of positive correlations between prevalence of resistance for different combinations of antibiotics/bacteria and septicemia hospitalization/sepsis mortality rates in adults.
AHRQ-authored.
Citation: Goldstein E, MacFadden DR, Karaca Z .
Antimicrobial resistance prevalence, rates of hospitalization with septicemia and rates of mortality with sepsis in adults in different US states.
Int J Antimicrob Agents 2019 Jul;54(1):23-34. doi: 10.1016/j.ijantimicag.2019.03.004..
Keywords: Antibiotics, Antimicrobial Stewardship, Healthcare Cost and Utilization Project (HCUP), Hospitals, Hospitalization, Medication, Mortality, Sepsis
Chiotos K, Tamma PD, Gerber JS
Antibiotic stewardship in the intensive care unit: challenges and opportunities.
This study examined unique considerations and knowledge gaps in antibiotic stewardship intervention in the intensive care unit (ICU). There is limited data available, but the available data was summarized and included the impact of prospective audit and feedback, diagnostic test stewardship, rapid molecular diagnostic tests, and procalcitonin-guided algorithms for antibiotic discontinuation.
AHRQ-funded; HS026393.
Citation: Chiotos K, Tamma PD, Gerber JS .
Antibiotic stewardship in the intensive care unit: challenges and opportunities.
Infect Control Hosp Epidemiol 2019 Jun;40(6):693-98. doi: 10.1017/ice.2019.74..
Keywords: Antimicrobial Stewardship, Antibiotics, Intensive Care Unit (ICU), Critical Care, Antibiotics
Gong CL, Zangwill KM, Hay JW
Behavioral economics interventions to improve outpatient antibiotic prescribing for acute respiratory infections: a cost-effectiveness analysis.
Researchers sought to determine the cost-effectiveness of three behavioral economic interventions designed to reduce inappropriate antibiotic prescriptions for acute respiratory infections (ARIs). Provider education on guidelines for the appropriate ARI treatment is compared with suggested alternatives, which use computerized clinical decision support to suggest non-antibiotic treatment choices; accountable justification, which mandates free-text justification into the patient's electronic health record when antibiotics are prescribed; and peer comparison. The authors concluded that behavioral economics interventions can be cost-effective strategies for reducing inappropriate antibiotic prescriptions by reducing healthcare resource utilization.
AHRQ-funded; HS019913.
Citation: Gong CL, Zangwill KM, Hay JW .
Behavioral economics interventions to improve outpatient antibiotic prescribing for acute respiratory infections: a cost-effectiveness analysis.
J Gen Intern Med 2019 Jun;34(6):846-54. doi: 10.1007/s11606-018-4467-x..
Keywords: Antibiotics, Antimicrobial Stewardship, Medication, Practice Patterns, Healthcare Costs, Respiratory Conditions
Monsees EA, Tamma PD, Cosgrove SE
AHRQ Author: Miller MA
Integrating bedside nurses into antibiotic stewardship: a practical approach.
This study looked into a framework for nurses to integrate antibiotic stewardship (AS) into their clinical work with patients. The practices that nurses can take include improving antibiotic prescribing practices through appropriate obtainment of Cloistridioides difficile tests, appropriate urine culturing practices, optimal antibiotic administration, accurate and detailed documentation of antibiotic allergy histories, and through the prompting of antibiotic time outs. Barriers were also identified to engagement of nurses in AS and offered potential solutions.
AHRQ-authored; AHRQ-funded; 233201500020I.
Citation: Monsees EA, Tamma PD, Cosgrove SE .
Integrating bedside nurses into antibiotic stewardship: a practical approach.
Infect Control Hosp Epidemiol 2019 May;40(5):579-84. doi: 10.1017/ice.2018.362..
Keywords: Antibiotics, Antimicrobial Stewardship, Guidelines, Healthcare-Associated Infections (HAIs), Medication, Nursing, Patient Safety
Krah NM, Bardsley T, Nelson R
Economic burden of home antimicrobial therapy: OPAT versus oral therapy.
There is increasing evidence that outpatient parenteral antimicrobial therapy (OPAT) is overused for children and that outcomes with oral therapy are equivalent. The objective of this study was to compare economic burden between OPAT and oral therapy, accounting for direct and indirect costs and caregiver quality of life (QoL). The investigators concluded that the overall burden of OPAT was substantially higher than that of oral therapy, including higher direct and indirect costs and greater impact on caregiver QoL.
AHRQ-funded; HS023320.
Citation: Krah NM, Bardsley T, Nelson R .
Economic burden of home antimicrobial therapy: OPAT versus oral therapy.
Hosp Pediatr 2019 Apr;9(4):234-40. doi: 10.1542/hpeds.201-0193.
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Keywords: Healthcare Costs, Children/Adolescents, Caregiving, Home Healthcare, Antimicrobial Stewardship, Antibiotics, Medication
Pulia M, Fox B
Antibiotics should not be routinely prescribed after incision and drainage of uncomplicated abscesses.
This article considers recent challenges to the 2013 antimicrobial stewardship recommendation from the American College of Emergency Physicians on avoidance of systemic antibiotic therapy after adequate incision and drainage of uncomplicated abscesses. Although the latest results from randomized controlled trials indicate that there are benefits in favoring antibiotics in the management of uncomplicated abscesses, the authors note that these results have also ‘paradoxically given rise to a unique clinical dilemma that carries significant public health implications’ and may lead to tens of thousands of patients receiving unnecessary antibiotics treatment each year. To limit development of unnecessary antibiotic resistance and reduce possible adverse reactions to antibiotics, the authors propose that antibiotic usage for uncomplicated abscesses be considered only for high-risk patients, such as those with immunocompromised status, a history of MRSA infections, or limited access to follow-up care.
AHRQ-funded; HS024342.
Citation: Pulia M, Fox B .
Antibiotics should not be routinely prescribed after incision and drainage of uncomplicated abscesses.
Ann Emerg Med 2019 Apr;73(4):377-78. doi: 10.1016/j.annemergmed.2018.04.026..
Keywords: Antibiotics, Antimicrobial Stewardship, Shared Decision Making, Medication
Gross AE, Hanna D, Rowan SA
Successful implementation of an antibiotic stewardship program in an academic dental practice.
Researchers created a comprehensive antibiotic stewardship program (ASP) for dental practices. A baseline needs assessment and literature evaluation was conducted by a team of dentists, pharmacists, and physician leaders. An academic dental center in Illinois that is the state’s largest oral health provider for Medicaid recipients was used. After intervention with the ASP, there was a 72.9% decrease in antibiotic prescribing for urgent care visits.
AHRQ-funded; HS025177.
Citation: Gross AE, Hanna D, Rowan SA .
Successful implementation of an antibiotic stewardship program in an academic dental practice.
Open Forum Infect Dis 2019 Mar;6(3):ofz067. doi: 10.1093/ofid/ofz067..
Keywords: Antibiotics, Antimicrobial Stewardship, Dental and Oral Health, Medication, Patient Safety
Mistry RD, May LS, Pulia MS
Improving antimicrobial stewardship in pediatric emergency care: a pathway forward.
In this commentary, the authors discuss a study in this same issue. Recent multidisciplinary teams have used novel methods to successfully engage with and intervene in urgent care, pediatric, and general–emergency department antibiotic prescribing. Antibiotic stewardship programs are recommended, as well as emergency department experts continuing to collaborate and formulate thoughtful solutions to this important patient-safety and public-health issue.
AHRQ-funded; HS024342.
Citation: Mistry RD, May LS, Pulia MS .
Improving antimicrobial stewardship in pediatric emergency care: a pathway forward.
Pediatrics 2019 Feb;143(2). doi: 10.1542/peds.2018-2972..
Keywords: Antimicrobial Stewardship, Antibiotics, Children/Adolescents, Emergency Department, Medication, Patient Safety
Karandikar MV, Coffin SE, Priebe GP
Variability in antimicrobial use in pediatric ventilator-associated events.
This article describes a study which assesses variability in antimicrobial use and associations with infection testing in pediatric ventilator-associated events (VAEs). 192 patients with ventilator-associated conditions were identified in neonatal, pediatric, and cardiac ICUs in six hospitals. Type and duration of antimicrobial use varied by ICU type. The authors conclude that antimicrobial use is common in pediatric ventilator-associated conditions, but pediatric VAP is uncommon; prolonged usage of antimicrobials in spite of low pediatric VAP rates or positive laboratory testing for infection suggests that pediatric ventilator-associated conditions with antimicrobial use for >/= 4 days may provide a lever for antimicrobial stewardship programs to improve utilization.
AHRQ-funded; HS021636.
Citation: Karandikar MV, Coffin SE, Priebe GP .
Variability in antimicrobial use in pediatric ventilator-associated events.
Infect Control Hosp Epidemiol 2019 Jan;40(1):32-39. doi: 10.1017/ice.2018.264..
Keywords: Adverse Events, Antimicrobial Stewardship, Children/Adolescents, Healthcare-Associated Infections (HAIs), Respiratory Conditions