National Healthcare Quality and Disparities Report
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AHRQ Research Studies Date
Topics
- Adverse Drug Events (ADE) (3)
- Adverse Events (3)
- Ambulatory Care and Surgery (2)
- Antibiotics (17)
- (-) Antimicrobial Stewardship (19)
- Caregiving (1)
- Children/Adolescents (3)
- Clinical Decision Support (CDS) (2)
- Community-Acquired Infections (1)
- Critical Care (1)
- Decision Making (2)
- Digestive Disease and Health (1)
- Education: Patient and Caregiver (2)
- Elderly (4)
- Health Literacy (1)
- Infectious Diseases (1)
- Intensive Care Unit (ICU) (1)
- Long-Term Care (3)
- Medicaid (1)
- Medication (17)
- Medication: Safety (1)
- Nursing Homes (4)
- Patient-Centered Healthcare (1)
- Patient Safety (4)
- Pneumonia (1)
- Practice Patterns (3)
- Primary Care (2)
- Provider (2)
- Provider: Clinician (1)
- Provider: Physician (2)
- Quality Improvement (2)
- Quality of Care (2)
- Respiratory Conditions (2)
- Risk (2)
- Surgery (1)
- Workflow (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 19 of 19 Research Studies DisplayedDaniel VT, Francalancia S, Amir NS
Upper gastrointestinal perforations: a possible danger of antibiotic overuse.
Investigators conducted a retrospective case-control study to examine the relationship between antibiotic exposure and upper gastrointestinal (UGI) perforations in a national sample. A 5% random sample of Medicare were queried to identify patients at least 65 years old who were hospitalized with stomach or small intestine UGI perforations using International Classification of Diseases diagnosis codes; Cases with UGI perforations were matched with 4 controls based on age and sex. The investigators concluded that recent outpatient antibiotic use, in particular in the preceding 30 days, is associated with UGI perforation among Medicare beneficiaries. They recommended minimizing exposure to antibiotics in the outpatient setting.
AHRQ-funded; HS022694.
Citation: Daniel VT, Francalancia S, Amir NS .
Upper gastrointestinal perforations: a possible danger of antibiotic overuse.
J Gastrointest Surg 2020 Dec;24(12):2730-36. doi: 10.1007/s11605-019-04473-w..
Keywords: Digestive Disease and Health, Antimicrobial Stewardship, Antibiotics, Medication, Adverse Drug Events (ADE), Adverse Events
Miller BJ, Carson KA, Keller S
Educating patients on unnecessary antibiotics: personalizing potential harm aids patient understanding.
Antibiotic resistance is a public health emergency fueled by inappropriate antibiotic use. Public education campaigns often focus on global antibiotic resistance or societal harm of antibiotic misuse. In this study, the investigators administered a survey at a primary care clinic in Baltimore, MD. A total of 250 participants rated 18 statements about potential harm from antibiotics on how each statement changed their likelihood to request antibiotics for an upper respiratory tract infection.
AHRQ-funded; HS025782.
Citation: Miller BJ, Carson KA, Keller S .
Educating patients on unnecessary antibiotics: personalizing potential harm aids patient understanding.
J Am Board Fam Med 2020 Nov-Dec;33(6):969-77. doi: 10.3122/jabfm.2020.06.200210..
Keywords: Antimicrobial Stewardship, Antibiotics, Education: Patient and Caregiver, Medication, Respiratory Conditions, Health Literacy
Ramly E, Tong M, Bondar S
Workflow barriers and strategies to reduce antibiotic overuse in nursing homes.
Antibiotic overuse is a significant problem in nursing homes (NHs). Strategies to improve antibiotic prescribing practices in NHs are a critical need. In this study, the investigators analyzed antibiotic prescribing workflows to identify strategies for improving antibiotic prescribing in NHs. They found that such strategies included structured information tools, nurse and prescriber education, and organizational improvement.
AHRQ-funded; HS022465.
Citation: Ramly E, Tong M, Bondar S .
Workflow barriers and strategies to reduce antibiotic overuse in nursing homes.
J Am Geriatr Soc 2020 Oct;68(10):2222-31. doi: 10.1111/jgs.16632..
Keywords: Workflow, Antibiotics, Medication, Nursing Homes, Long-Term Care, Elderly, Antimicrobial Stewardship, Practice Patterns
Schimmel JJ, Haessler S, Imrey P
Pneumococcal urinary antigen testing in United States hospitals: a missed opportunity for antimicrobial stewardship.
The Infectious Disease Society of America recommends pneumococcal urinary antigen testing (UAT) when identifying pneumococcal infection would allow for antibiotic de-escalation. However, the frequencies of UAT and subsequent antibiotic de-escalation are unknown. The authors conducted this retrospective cohort study of adult patients admitted with community-acquired or healthcare-associated pneumonia to 170 US hospitals in the Premier database from 2010-2015, to describe variation in UAT use, associations of UAT results with antibiotic de-escalation, and associations of de-escalation with outcomes.
AHRQ-funded; HS024277.
Citation: Schimmel JJ, Haessler S, Imrey P .
Pneumococcal urinary antigen testing in United States hospitals: a missed opportunity for antimicrobial stewardship.
Clin Infect Dis 2020 Sep 12;71(6):1427-34. doi: 10.1093/cid/ciz983..
Keywords: Antimicrobial Stewardship, Community-Acquired Infections, Infectious Diseases, Pneumonia
Patterson ES, DiLoreto GN, Vanam R
Enhancing usefulness and usability of a clinical decision support prototype for antibiotic stewardship.
This paper describes a multi-method approach to improve clinical decision support (CDS) for antibiotic stewardship. A heuristic review was employed to generate recommendations to improve the usability of a prototype CDS in the hospital setting. The authors then engaged in a design improvement cycle in collaboration with software programmers that enhanced their prototype. The revised prototype was then demonstrated to physician and pharmacist subject matter experts in three walkthrough interviews. These interviews generated recommendations to improve the interface, functionality, and tailoring for groups of users. Common elements for the recommendations are discussed for models for using clinical decision support in general.
AHRQ-funded; HS024379.
Citation: Patterson ES, DiLoreto GN, Vanam R .
Enhancing usefulness and usability of a clinical decision support prototype for antibiotic stewardship.
Proc Int Symp Hum Factors Ergon Healthc 2020 Sep;9(1):61-65. doi: 10.1177/2327857920091034..
Keywords: Clinical Decision Support (CDS), Decision Making, Antimicrobial Stewardship, Antibiotics, Medication
Tischendorf J, Brunner M, Knobloch MJ
Evaluation of a successful fluoroquinolone restriction intervention among high-risk patients: a mixed-methods study.
In this study, the investigators conducted a quality improvement initiative to restrict fluoroquinolone prescribing on two inpatient units housing high-risk patients and applied a human factors approach to understanding the barriers and facilitators to success of this intervention by front-line providers. The authors concluded that Fluoroquinolones can be safely restricted even among high-risk patients without negatively impacting length of stay, readmissions or mortality. Their study provides a framework for successful antimicrobial stewardship interventions informed by perceptions of front line providers.
AHRQ-funded; HS026226.
Citation: Tischendorf J, Brunner M, Knobloch MJ .
Evaluation of a successful fluoroquinolone restriction intervention among high-risk patients: a mixed-methods study.
PLoS One 2020 Aug 25;15(8):e0237987. doi: 10.1371/journal.pone.0237987..
Keywords: Antimicrobial Stewardship, Antibiotics, Medication, Risk
Zetts RM, Stoesz A, Garcia AM
Primary care physicians' attitudes and perceptions towards antibiotic resistance and outpatient antibiotic stewardship in the USA: a qualitative study.
Outpatient antibiotic stewardship is needed to improve prescribing and address the threat of antibiotic resistance. A better understanding of primary care physicians (PCPs) attitudes towards antibiotic prescribing and outpatient antibiotic stewardship is needed to identify barriers to stewardship implementation and help tailor stewardship strategies. The aim of this study was to assess PCPs current attitudes towards antibiotic resistance, inappropriate antibiotic prescribing and the feasibility of outpatient stewardship efforts.
AHRQ-funded; HS026506; HS024930; 233201500020I.
Citation: Zetts RM, Stoesz A, Garcia AM .
Primary care physicians' attitudes and perceptions towards antibiotic resistance and outpatient antibiotic stewardship in the USA: a qualitative study.
BMJ Open 2020 Jul 14;10(7):e034983. doi: 10.1136/bmjopen-2019-034983..
Keywords: Primary Care, Antimicrobial Stewardship, Antibiotics, Medication, Provider: Physician, Provider
Nace DA, Hanlon JT, Crnich CJ
A multifaceted antimicrobial stewardship program for the treatment of uncomplicated cystitis in nursing home residents.
This study describes the result of implementing a multifaceted antimicrobial stewardship program to reduce antibiotic use in nursing homes for urinary tract infections that are unlikely cystitis. Reduction in antibiotic use decreases incidence of Clostridioides difficile (C difficile) infections, as well as adverse drug reactions and antimicrobial drug resistance. This one-year case-control study included 12 intervention nursing homes and 13 control group nursing homes. The intervention nursing homes received a 1-hour introductory webinar, pocket-sized educational cards, tools for system change, and educational clinical vignettes addressing the diagnosis and treatment of suspected uncomplicated cystitis. Additionally, they received a monthly coaching call as well as a quarterly feedback report. In the intervention nursing homes, fewer unlikely cystitis cases were treated with antibiotics and C difficile infection rates were also lower. There was no increase in all-cause hospitalizations or deaths due to the intervention.
AHRQ-funded; HS023779.
Citation: Nace DA, Hanlon JT, Crnich CJ .
A multifaceted antimicrobial stewardship program for the treatment of uncomplicated cystitis in nursing home residents.
JAMA Intern Med 2020 Jul;180(7):944-51. doi: 10.1001/jamainternmed.2020.1256..
Keywords: Antimicrobial Stewardship, Antibiotics, Nursing Homes, Elderly, Quality Improvement, Quality of Care, Medication
Liao CY, Nace DA, Crnich CJ
Effect of antibiotic time-outs on modification of antibiotic prescriptions in nursing homes.
The purpose of this study was to evaluate the impact of a stewardship intervention, promoting the use of antibiotic time-outs (ATOs) on the frequency and types of antibiotic change events (ACEs) in nursing homes. Data on antibiotic prescriptions in 11 nursing homes were collected over 25 months and categorized as early discontinuation, class modification, or administration modification ACEs. Findings showed that the impact of an ATO intervention in study nursing homes was mixed with increases in early discontinuation ACEs offset by reductions in class modification ACEs. Recommendations include further research on the potential value of ATO interventions in nursing homes.
AHRQ-funded; HS022465.
Citation: Liao CY, Nace DA, Crnich CJ .
Effect of antibiotic time-outs on modification of antibiotic prescriptions in nursing homes.
Infect Control Hosp Epidemiol 2020 Jun;41(6):635-40. doi: 10.1017/ice.2020.75..
Keywords: Antimicrobial Stewardship, Antibiotics, Medication, Nursing Homes, Long-Term Care, Elderly
Malone SM, Seigel NS, Newland JG
Understanding antibiotic prophylaxis prescribing in pediatric surgical specialties.
The objective of this study was to understand the factors that contribute to pediatric surgeons' decisions regarding the use of perioperative antibiotic prophylaxis. The investigators found that surgeons described a complex set of factors that impacted their antibiotic prescribing in pediatric surgical cases. They reported initial, but not ongoing, training and a use of individual weight of risk and benefit as a major dictator of prescribing practices.
AHRQ-funded; HS026742.
Citation: Malone SM, Seigel NS, Newland JG .
Understanding antibiotic prophylaxis prescribing in pediatric surgical specialties.
Infect Control Hosp Epidemiol 2020 Jun;41(6):666-71. doi: 10.1017/ice.2020.71..
Keywords: Children/Adolescents, Antibiotics, Surgery, Antimicrobial Stewardship, Medication, Practice Patterns
Rowe TA, Linder JA
Delayed antibiotic prescriptions in ambulatory care: reconsidering a problematic practice.
In this paper, the authors discuss delayed or backup antibiotic prescriptions, which are given to ambulatory patients with the expectation that the patient will pick up or fill the prescription if he or she is not improving within a few days. They discuss the drawbacks of delayed antibiotic prescriptions and the options for clinicians.
AHRQ-funded; HS024930; HS026506; 2332015000201.
Citation: Rowe TA, Linder JA .
Delayed antibiotic prescriptions in ambulatory care: reconsidering a problematic practice.
JAMA 2020 May 12;323(18):1779-80. doi: 10.1001/jama.2020.2325..
Keywords: Antibiotics, Medication, Ambulatory Care and Surgery, Medication: Safety, Patient Safety, Antimicrobial Stewardship
Trubiano JA, Vogrin S, Chua KYL
Development and validation of a penicillin allergy clinical decision rule.
Penicillin allergy is a significant public health issue for patients, antimicrobial stewardship programs, and health services. Validated clinical decision rules are urgently needed to identify low-risk penicillin allergies that potentially do not require penicillin skin testing by a specialist. The objective of this study was to develop and validate a penicillin allergy clinical decision rule that enables point-of-care risk assessment of patient-reported penicillin allergies.
AHRQ-funded; HS026395.
Citation: Trubiano JA, Vogrin S, Chua KYL .
Development and validation of a penicillin allergy clinical decision rule.
JAMA Intern Med 2020 May;180(5):745-52. doi: 10.1001/jamainternmed.2020.0403..
Keywords: Antimicrobial Stewardship, Antibiotics, Medication, Clinical Decision Support (CDS), Risk
Patel A, Pfoh ER, Misra Hebert AD
Attitudes of high versus low antibiotic prescribers in the management of upper respiratory tract infections: a mixed methods study.
The authors sought to identify factors associated with high and low prescriber status for the management of upper respiratory tract infections (URTIs) in primary care practice. They found that physicians reported that nonclinical factors frequently influenced their decision to prescribe antibiotics for URTIs, with concerns regarding antibiotic side effects and patient satisfaction being important factors in the decision-making process. They concluded that changes in the health system addressing both physicians and patients may be necessary to attain desired prescribing levels.
AHRQ-funded; HS024128; HS024277.
Citation: Patel A, Pfoh ER, Misra Hebert AD .
Attitudes of high versus low antibiotic prescribers in the management of upper respiratory tract infections: a mixed methods study.
J Gen Intern Med 2020 Apr;35(4):1182-88. doi: 10.1007/s11606-019-05433-5.
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Keywords: Antimicrobial Stewardship, Antibiotics, Medication, Respiratory Conditions, Primary Care
Kohut MR, Keller SC, Linder JA
AHRQ Author: Miller MA
The inconvincible patient: how clinicians perceive demand for antibiotics in the outpatient setting.
Researchers conducted semi-structured interviews with clinicians to determine how they perceive demand for antibiotics in the outpatient setting. They conducted interviews with 25 clinicians from nine practices across three states. Patient demand was the most common reason why non-indicated antibiotics were prescribed. Clinicians felt that if they didn’t prescribe them they would experience repercussions in their reputation and practice and that certain patients are impossible to please without an antibiotic prescription regardless of the diagnosis.
AHRQ-authored; AHRQ-funded; 233201500020I.
Citation: Kohut MR, Keller SC, Linder JA .
The inconvincible patient: how clinicians perceive demand for antibiotics in the outpatient setting.
Fam Pract 2020 Mar 25;37(2):276-82. doi: 10.1093/fampra/cmz066..
Keywords: Antibiotics, Medication, Antimicrobial Stewardship, Ambulatory Care and Surgery, Provider: Clinician, Provider: Physician, Provider
Keller SC, Cosgrove SE, Arbaje AI
It's complicated: patient and informal caregiver performance of outpatient parenteral antimicrobial therapy-related tasks.
This study’s objective was to perform a patient-centered goal-directed task analysis to identify what is required for successful completion of outpatient parenteral antimicrobial therapy (OPAT) by patients and caregivers. The authors conducted 40 semi-structured patient interviews and also 20 observations of patients and caregivers performing OPAT. Six goals were identified. The authors concluded that patients and caregivers should use teach-back, take formal classes, and other forms of instruction to ensure safety and good outcomes for the patients.
AHRQ-funded; HS025782.
Citation: Keller SC, Cosgrove SE, Arbaje AI .
It's complicated: patient and informal caregiver performance of outpatient parenteral antimicrobial therapy-related tasks.
Am J Med Qual 2020 Mar/Apr;35(2):133-46. doi: 10.1177/1062860619853345..
Keywords: Caregiving, Patient-Centered Healthcare, Antimicrobial Stewardship, Medication, Education: Patient and Caregiver, Patient Safety
Pulia MS, Keller SC, Crnich CJ
Antibiotic stewardship for older adults in ambulatory care settings: addressing an unmet challenge.
Inappropriate antibiotic use is common in older adults (aged >65 y), and they are particularly vulnerable to serious antibiotic-associated adverse effects such as cardiac arrhythmias, delirium, aortic dissection, drug-drug interactions, and Clostridioides difficile. In this study, to help improve the clinical care of older adults, the investigators reviewed drivers of antibiotic prescribing in this population, explored systems aspects of ambulatory care that can create barriers to optimal antibiotic use, discussed existing stewardship interventions, and provided guidance on priority areas for future inquiry.
AHRQ-funded; HS024342.
Citation: Pulia MS, Keller SC, Crnich CJ .
Antibiotic stewardship for older adults in ambulatory care settings: addressing an unmet challenge.
J Am Geriatr Soc 2020 Feb;68(2):244-49. doi: 10.1111/jgs.16256..
Keywords: Antimicrobial Stewardship, Antibiotics, Medication, Elderly, Patient Safety, Adverse Drug Events (ADE), Adverse Events
Fischer MA, Mahesri M, Lii J
Non-Infection-related and non-visit-based antibiotic prescribing is common among Medicaid patients.
This study examined antibiotic prescribing by clinicians when there was no visit or without clear indications for use. The authors discuss the fact that current ambulatory antibiotic stewardship policies do not capture prescribing outside of clinician visits or clear indications for use. They measured the frequency for all filled antibiotic prescriptions in Medicaid patients in the period 2004-2013. They found that out of 298 million antibiotic fills for 53 million patients (62% for children), 55% were for clinician visits with an infection-related diagnosis, 17% were for visits without an infection-related diagnosis, and 28% were not associated with a visit.
AHRQ-funded; HS024930; HS023236; HS024651; HS026506; 2332015000201.
Citation: Fischer MA, Mahesri M, Lii J .
Non-Infection-related and non-visit-based antibiotic prescribing is common among Medicaid patients.
Health Aff 2020 Feb;39(2):280-88. doi: 10.1377/hlthaff.2019.00545..
Keywords: Antimicrobial Stewardship, Medicaid, Antibiotics, Medication, Practice Patterns, Children/Adolescents
Simpson KR, Lyndon A, Spetz J
A 2-year pragmatic trial of antibiotic stewardship in 27 community nursing homes.
The purpose of this study was to determine associations between missed nursing care and nurse staffing during labor and birth, and exclusive breast milk feeding at hospital discharge. Exclusive breast milk feeding is a national quality indicator of inpatient maternity care. Nurses have substantial responsibility for direct support of infant feeding during the childbirth hospitalization. The investigators indicate that the results support exclusive breast milk feeding as a nurse-sensitive quality indicator.
AHRQ-funded; HS022846.
Citation: Simpson KR, Lyndon A, Spetz J .
A 2-year pragmatic trial of antibiotic stewardship in 27 community nursing homes.
J Am Geriatr Soc 2020 Jan;68(1):46-54. doi: 10.1111/jgs.16059..
Keywords: Antibiotics, Medication, Antimicrobial Stewardship, Nursing Homes, Long-Term Care, Quality Improvement, Quality of Care
Woods-Hill CZ, Koontz DW, King AF
Practices, perceptions, and attitudes in the evaluation of critically ill children for bacteremia: a national survey.
Sending blood cultures in children at low risk of bacteremia can contribute to a cascade of unnecessary antibiotic exposure, adverse effects, and increased costs. In this study, the investigators aimed to describe practice variation, clinician beliefs, and attitudes about blood culture testing in critically ill children. They concluded that there is variation in blood culture practices in the pediatric ICU. Fear and reflexive habits are common drivers of cultures. These practices may contribute to over-testing for bacteremia.
AHRQ-funded; HS025642.
Citation: Woods-Hill CZ, Koontz DW, King AF .
Practices, perceptions, and attitudes in the evaluation of critically ill children for bacteremia: a national survey.
Pediatr Crit Care Med 2020 Jan;21(1):e23-e29. doi: 10.1097/pcc.0000000000002176..
Keywords: Children/Adolescents, Critical Care, Antimicrobial Stewardship, Antibiotics, Adverse Drug Events (ADE), Adverse Events, Patient Safety, Intensive Care Unit (ICU), Decision Making