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Search All Research Studies
Topics
- Adverse Drug Events (ADE) (2)
- Adverse Events (2)
- Ambulatory Care and Surgery (2)
- (-) Antibiotics (15)
- (-) Antimicrobial Stewardship (15)
- Children/Adolescents (2)
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- Quality of Care (1)
- Sepsis (1)
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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 15 of 15 Research Studies DisplayedKeller SC, Cosgrove SE, Miller MA
AHRQ Author: Miller MA
A framework for implementing antibiotic stewardship in ambulatory care: lessons learned from the Agency for Healthcare Research and Quality Safety Program for Improving Antibiotic Use.
This article used lessons learned from AHRQ’s Safety Program for Improving Antibiotic Use in Ambulatory Care to describe a step-by-step framework that assists practices with establishing antibiotic stewardship in outpatient settings. These steps include: obtaining support from practice leadership; establishing antibiotic stewardship teams; garnering support from practice members; building communication skills around antibiotic use; implementing educational content around an infectious syndrome; accessing and monitoring antibiotic prescribing data; and implementing a sustainability plan.
AHRQ-authored; AHRQ-funded; 233201500020I.
Citation: Keller SC, Cosgrove SE, Miller MA .
A framework for implementing antibiotic stewardship in ambulatory care: lessons learned from the Agency for Healthcare Research and Quality Safety Program for Improving Antibiotic Use.
Antimicrob Steward Healthc Epidemiol 2022 Jul 4;2(1):e109. doi: 10.1017/ash.2022.258..
Keywords: Antibiotics, Antimicrobial Stewardship, Medication, Ambulatory Care and Surgery, Patient Safety
Katz MJ, Tamma PD, Cosgrove SE
Implementation of an antibiotic stewardship program in long-term care facilities across the US.
The purpose of this study was to determine if AHRQ’s Safety Program for Improving Antibiotic Use was associated with reductions in antibiotic use in long-term care (LTC) facilities in the US. Findings showed that participation in the AHRQ safety program was associated with the development of antibiotic stewardship programs (ASPs) that actively engaged clinical staff in the decision-making processes around antibiotic prescriptions in participating LTC facilities. The reduction in days of antibiotic therapy and starts, which was more pronounced in more engaged facilities, indicated that implementation of this multifaceted program may support successful ASPs in LTC settings.
AHRQ-funded; 233201500020I.
Citation: Katz MJ, Tamma PD, Cosgrove SE .
Implementation of an antibiotic stewardship program in long-term care facilities across the US.
JAMA Netw Open 2022 Feb;5(2):e220181. doi: 10.1001/jamanetworkopen.2022.0181..
Keywords: Elderly, Antimicrobial Stewardship, Antibiotics, Long-Term Care, Medication, Implementation, Patient Safety
Tamma PD, Miller MA, Cosgrove SE
AHRQ Author: Miller MA
Recalibrating our approach to the management of sepsis: how the four moments of antibiotic decision-making can help.
In this paper, the authors describe The Four Moments of Antibiotic Decision Making. The Four Moments were conceived as part of the Agency for Healthcare Research and Quality (AHRQ) Safety Program for Improving Antibiotic Use. The Four Moments provide a pragmatic approach to the core principle of antibiotic stewardship – ensuring patients who require antibiotic therapy promptly receive regimens associated with clinical success, while protecting patients from potential harm associated with unnecessary exposure to antibiotics.
AHRQ-authored; AHRQ-funded; 233201500020I.
Citation: Tamma PD, Miller MA, Cosgrove SE .
Recalibrating our approach to the management of sepsis: how the four moments of antibiotic decision-making can help.
Ann Am Thorac Soc 2021 Feb;18(2):200-03. doi: 10.1513/AnnalsATS.202005-484IP..
Keywords: Sepsis, Antibiotics, Antimicrobial Stewardship, Medication, Decision Making, Medication: Safety, Patient Safety
Tamma PD, Miller MA, Dullabh P
AHRQ Author: Miller MA
Association of a safety program for improving antibiotic use with antibiotic use and hospital-onset Clostridioides difficile infection rates among US hospitals.
Regulatory agencies and professional organizations recommend antibiotic stewardship programs (ASPs) in US hospitals. The optimal approach to establish robust, sustainable ASPs across diverse hospitals is unknown. The purpose of this study was to assess whether the Agency for Healthcare Research and Quality (AHRQ) Safety Program for Improving Antibiotic Use was associated with reductions in antibiotic use across US hospitals. The investigators concluded that AHRQ Safety Program appeared to enable diverse hospitals to establish ASPs and teach frontline clinicians to self-steward their antibiotic use.
AHRQ-authored; AHRQ-funded; 233201500020I.
Citation: Tamma PD, Miller MA, Dullabh P .
Association of a safety program for improving antibiotic use with antibiotic use and hospital-onset Clostridioides difficile infection rates among US hospitals.
JAMA Netw Open 2021 Feb;4(2):e210235. doi: 10.1001/jamanetworkopen.2021.0235..
Keywords: Antimicrobial Stewardship, Antibiotics, Medication, Decision Making, Clostridium difficile Infections, Patient Safety, Quality Improvement, Quality of Care, Hospitals
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
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
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
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
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
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
Kline SE, Sanstead EC, Johnson JR
Cost-effectiveness of pre-operative Staphylococcus aureus screening and decolonization.
In this study, the investigators developed a decision analytic model to evaluate the impact of a preoperative Staphylococcus aureus decolonization bundle on surgical site infections (SSIs), health-care-associated costs (HCACs), and deaths due to SSI. The investigators predict that the treat-all strategy would be the most effective and cost-saving strategy for preventing SSIs. However, they concluded that because this strategy might select more extensively for mupirocin-resistant S. aureus and cause more medication adverse effects than the test-and-treat approach or the SOC, additional studies are needed to define its comparative benefits and harms.
AHRQ-funded; HS022912.
Citation: Kline SE, Sanstead EC, Johnson JR .
Cost-effectiveness of pre-operative Staphylococcus aureus screening and decolonization.
Infect Control Hosp Epidemiol 2018 Nov;39(11):1340-46. doi: 10.1017/ice.2018.228..
Keywords: Surgery, Antibiotics, Antimicrobial Stewardship, Healthcare-Associated Infections (HAIs), Infectious Diseases, Patient Safety, Prevention, Healthcare Costs
Johnson SP, Zhong L, Chung KC
Perioperative antibiotics for clean hand surgery: a national study.
This research is a national study on the use of prophylactic antibiotics in soft tissue hand surgery when antimicrobials are not indicated. Insurance claims from the Truven MarketScan Databases were used to identify patients who had 1 of 5 outpatient surgery procedures including: open or endoscopic carpal tunnel release; trigger finger release; de Ouervain release, and wrist ganglion excision between 2009 and 2015. An increase of 72.5% in prophylactic intravenous antibiotics was shown from 2009 to 2015. Patients with a younger age, male sex, lower income, or obesity had higher odds of receiving antibiotics. Total charge for these antibiotics equaled $1.6 million.
AHRQ-funded; HS023313.
Citation: Johnson SP, Zhong L, Chung KC .
Perioperative antibiotics for clean hand surgery: a national study.
J Hand Surg Am 2018 May;43(5):407-16.e1. doi: 10.1016/j.jhsa.2017.11.018..
Keywords: Antibiotics, Antimicrobial Stewardship, Healthcare-Associated Infections (HAIs), Infectious Diseases, Medication, Patient Safety, Surgery
Burnham CA, Hogan PG, Wallace MA
Topical decolonization does not eradicate the skin microbiota of community-dwelling or hospitalized adults.
The authors compared microbial communities and levels of richness and diversity in community-dwelling subjects and in intensive care unit patients before and after the use of topical decolonization protocols. They found a reduction in S. aureus without eradicating endogenous microbiota.
AHRQ-funded; HS021736; HS024269.
Citation: Burnham CA, Hogan PG, Wallace MA .
Topical decolonization does not eradicate the skin microbiota of community-dwelling or hospitalized adults.
Antimicrob Agents Chemother 2016 Dec;60(12):7303-12. doi: 10.1128/aac.01289-16.
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Keywords: Antimicrobial Stewardship, Antibiotics, Infectious Diseases, Prevention, Patient Safety
Heid C, Knobloch MJ, Schulz LT
Use of the health belief model to study patient perceptions of antimicrobial stewardship in the acute care setting.
The authors identified themes associated with patient perceptions of antibiotic use and the role of patients in inpatient antimicrobial stewardship. They found that general medicine inpatients receiving at least one anti-infective medication recognized antibiotic resistance as a serious public health threat but expressed low perceived susceptibility to being personally affected by antibiotic resistance. Few participants reported being offered the opportunity to engage in shared decision making while hospitalized. The researchers concluded that the likelihood of patient engagement in stewardship practices is currently limited by low perceived susceptibility and lack of cues to act.
AHRQ-funded; HS023791.
Citation: Heid C, Knobloch MJ, Schulz LT .
Use of the health belief model to study patient perceptions of antimicrobial stewardship in the acute care setting.
Infect Control Hosp Epidemiol 2016 May;37(5):576-82. doi: 10.1017/ice.2015.342.
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Keywords: Critical Care, Antimicrobial Stewardship, Antibiotics, Patient and Family Engagement, Patient Safety