National Healthcare Quality and Disparities Report
Latest available findings on quality of and access to health care
Data
- Data Infographics
- Data Visualizations
- Data Tools
- Data Innovations
- All-Payer Claims Database
- Healthcare Cost and Utilization Project (HCUP)
- Medical Expenditure Panel Survey (MEPS)
- AHRQ Quality Indicator Tools for Data Analytics
- State Snapshots
- United States Health Information Knowledgebase (USHIK)
- Data Sources Available from AHRQ
Search All Research Studies
AHRQ Research Studies Date
Topics
- Adverse Drug Events (ADE) (7)
- Adverse Events (6)
- Ambulatory Care and Surgery (14)
- Antibiotics (119)
- (-) Antimicrobial Stewardship (157)
- Asthma (1)
- Caregiving (2)
- Case Study (1)
- Children/Adolescents (18)
- Chronic Conditions (4)
- Clinical Decision Support (CDS) (4)
- Clinician-Patient Communication (1)
- Clostridium difficile Infections (5)
- Communication (1)
- Community-Acquired Infections (4)
- Comparative Effectiveness (2)
- COVID-19 (3)
- Critical Care (12)
- Decision Making (8)
- Dental and Oral Health (3)
- Diagnostic Safety and Quality (4)
- Dialysis (1)
- Digestive Disease and Health (2)
- Education: Continuing Medical Education (2)
- Education: Patient and Caregiver (4)
- Elderly (14)
- Electronic Health Records (EHRs) (1)
- Emergency Department (1)
- Emergency Medical Services (EMS) (1)
- Evidence-Based Practice (3)
- Guidelines (5)
- Healthcare-Associated Infections (HAIs) (24)
- Healthcare Cost and Utilization Project (HCUP) (2)
- Healthcare Costs (6)
- Healthcare Utilization (2)
- Health Information Technology (HIT) (4)
- Health Insurance (1)
- Health Literacy (2)
- Health Services Research (HSR) (1)
- Home Healthcare (2)
- Hospital Discharge (6)
- Hospitalization (4)
- Hospitals (9)
- Imaging (1)
- Implementation (2)
- Infectious Diseases (16)
- Inpatient Care (5)
- Intensive Care Unit (ICU) (9)
- Kidney Disease and Health (3)
- Long-Term Care (15)
- Maternal Care (1)
- Medicaid (2)
- Medication (112)
- Medication: Safety (2)
- Methicillin-Resistant Staphylococcus aureus (MRSA) (8)
- Mortality (4)
- Neonatal Intensive Care Unit (NICU) (2)
- Newborns/Infants (5)
- Nursing (1)
- Nursing Homes (14)
- Outcomes (2)
- Palliative Care (2)
- Patient-Centered Healthcare (1)
- Patient-Centered Outcomes Research (2)
- Patient and Family Engagement (1)
- Patient Safety (33)
- Patient Self-Management (2)
- Pneumonia (5)
- Practice Patterns (13)
- Pregnancy (1)
- Prevention (20)
- Primary Care (4)
- Provider (3)
- Provider: Clinician (1)
- Provider: Health Personnel (1)
- Provider: Nurse (2)
- Provider: Physician (2)
- Public Health (1)
- Quality Improvement (4)
- Quality of Care (5)
- Racial and Ethnic Minorities (2)
- Registries (1)
- Research Methodologies (1)
- Respiratory Conditions (14)
- Risk (4)
- Sepsis (9)
- Skin Conditions (1)
- Surgery (8)
- Telehealth (1)
- Tools & Toolkits (1)
- Training (1)
- Transitions of Care (4)
- Urinary Tract Infection (UTI) (4)
- Women (1)
- Workflow (1)
AHRQ Research Studies
Sign up: AHRQ Research Studies Email updates
Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
26 to 50 of 157 Research Studies DisplayedPrescott HC, Seelye S, Wang XQ
Temporal trends in antimicrobial prescribing during hospitalization for potential infection and sepsis.
This study examined whether the push to administer antimicrobials to prevent sepsis has increased antimicrobial use in general. This observational cohort study of hospitalized patients at 152 hospitals in 2 health care systems during 2013 to 2018 looked at almost 1.6 million patients (81% male), admitted via the emergency department with 2 or more systemic inflammatory response syndrome (SIRS) criteria. From 2013 to 2018 first antimicrobial administration to patients with sepsis decreased by 37 minutes. At the same time, antimicrobial use within 48 hours, days of antimicrobial therapy, and receipt of broad-spectrum coverage decreased among the broader cohort of patients with systemic inflammatory response syndrome (SIRS). This may have caused a decrease in in-hospital mortality, 30-day mortality, length of hospitalization, new MDR culture positivity, and new MDR blood culture positivity over the study period among both patients with sepsis and those with SIRS. For the overall hospital population there was no evidence that increasing antimicrobial timing for sepsis was associated with increasing antimicrobial use or impaired antimicrobial stewardship.
AHRQ-funded; HS026725.
Citation: Prescott HC, Seelye S, Wang XQ .
Temporal trends in antimicrobial prescribing during hospitalization for potential infection and sepsis.
JAMA Intern Med 2022 Aug;182(8):805-13. doi: 10.1001/jamainternmed.2022.2291..
Keywords: Antimicrobial Stewardship, Antibiotics, Medication, Sepsis, Inpatient Care, Hospitals
Keller 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
Keller SC, Caballero TM, Tamma PD
AHRQ Author: Miller MA
Assessment of changes in visits and antibiotic prescribing during the Agency for Healthcare Research and Quality Safety Program for Improving Antibiotic Use and the COVID-19 pandemic.
This cohort study evaluated the effectiveness of the AHRQ Safety Program for Improving Antibiotic Use aimed to improve antibiotic prescribing in ambulatory practices by engaging clinicians and staff to incorporate antibiotic stewardship into practice culture, communication, and decision-making. The study ran from December 2019 through November 2020. A total of 389 ambulatory care practices with over 6.5 million visits to 5483 clinicians were compared from the baseline to completion of the program. Participants included 82 primary care practices, 103 urgent care practices, 34 federally supported practices, 21 pediatric-only practices, 39 pediatric urgent care practices, 21 pediatric-only practices, and 14 other practice types. Of the 389 practices who completed the program, 75% submitted completed data. Visits per practice per month decreased from a mean of 1624 at baseline to a nadir of 906 early in the COVID-19 pandemic (April 2020) and were 1797 at the end of the program. Total antibiotic prescribing decreased from 18.2% of visits at baseline to 9.5% at completion of the program. Acute respiratory infection (ARI) visits per practice per month decreased from a baseline of 321 to a nadir of 76 early in the pandemic (May 2020) and gradually increased through completion of the program (n = 239). Antibiotic prescribing for ARIs decreased from 39.2% at baseline to 24.7% at completion of the program.
AHRQ-authored; AHRQ-funded; 233201500020I.
Citation: Keller SC, Caballero TM, Tamma PD .
Assessment of changes in visits and antibiotic prescribing during the Agency for Healthcare Research and Quality Safety Program for Improving Antibiotic Use and the COVID-19 pandemic.
JAMA Netw Open 2022 Jul;5(7):e2220512. doi: 10.1001/jamanetworkopen.2022.20512..
Keywords: Antimicrobial Stewardship, Antibiotics, Medication, COVID-19, Public Health, Respiratory Conditions
Woods-Hill CZ, Colantuoni EA, Koontz DW
Association of diagnostic stewardship for blood cultures in critically ill children with culture rates, antibiotic use, and patient outcomes: results of the Bright STAR Collaborative.
The purpose of this AHRQ-funded prospective study was to assess the relationship between a 14-site PICU blood culture collaborative, the Bright STAR (Testing Stewardship for Antibiotic Reduction) collaborative, and culture rates, antibiotic use, and patient outcomes. The researchers collected data from each participating PICU across the United States and from the Children’s Hospital Association Pediatric Health Information System. The main outcome was blood culture rates, with secondary outcomes including: broad-spectrum antibiotic use and PICU rates of central line-associated bloodstream infection (CLABSI), Clostridioides difficile infection, readmission, length of stay, sepsis, severe sepsis/septic shock, and mortality. The study found that the blood culture rate preimplementation across the 14 PICUs was 149.4 per 1000 patient days per month, and the rate postimplementation was 100.5 for a 33% relative reduction postimplementation. For those same periods, the rate of antibiotic use decreased from 506 days per 1000 patient-days per month preimplementation to 440 days per 1000 patient-days per month postimplementation, which reflects a 13% relative reduction. Rates of CLABSI decreased from 1.8 to 1.1 per 1000 central venous line days per month, a 36% relative reduction. The variables of length of stay, readmission, sepsis, severe sepsis/septic shock, and mortality were similar before and after implementation. The researchers concluded that collaborative interventions can reduce blood culture and antibiotic use in the PICU.
AHRQ-funded; HS025642.
Citation: Woods-Hill CZ, Colantuoni EA, Koontz DW .
Association of diagnostic stewardship for blood cultures in critically ill children with culture rates, antibiotic use, and patient outcomes: results of the Bright STAR Collaborative.
JAMA Pediatr 2022 Jul;176(7):690-98. doi: 10.1001/jamapediatrics.2022.1024..
Keywords: Children/Adolescents, Sepsis, Critical Care, Antibiotics, Medication, Diagnostic Safety and Quality, Antimicrobial Stewardship
Uribe-Cano D, Bahranian M, Jolles SA
Comparison of criteria for determining appropriateness of antibiotic prescribing in nursing homes.
Researchers studied the extent to which the revised McGeer and Loeb criteria overlap and can be used interchangeably for tracking antibiotic appropriateness in nursing homes. Using a cross-sectional chart review in 5 Wisconsin nursing homes, they found that levels of agreement between the revised McGeer and Loeb criteria were moderate for urinary tract infections, fair for skin and soft-tissue infections, and slight for respiratory tract infections. They concluded that agreement between the revised McGeer and Loeb criteria is limited, and that nursing homes should employ the revised McGeer and Loeb criteria for their intended purposes.
AHRQ-funded; HS022465.
Citation: Uribe-Cano D, Bahranian M, Jolles SA .
Comparison of criteria for determining appropriateness of antibiotic prescribing in nursing homes.
Infect Control Hosp Epidemiol 2022 Jul;43(7):860-63. doi: 10.1017/ice.2021.221..
Keywords: Elderly, Nursing Homes, Long-Term Care, Antibiotics, Antimicrobial Stewardship, Medication
Giesler DL, Krein S, Brancaccio A
Reducing overuse of antibiotics at discharge home: a single-center mixed methods pilot study.
This article described a single-center, controlled pilot study of a pharmacist-facilitated antibiotic timeout prior to hospital discharge. The timeout addressed key elements of duration and was designed and implemented using iterative cycles with rapid feedback. The authors evaluated implementation outcomes related to feasibility, including usability, adherence, and acceptability. The pharmacists conducted 288 antibiotic timeouts with a mean duration of 2.5 minutes. Pharmacists recommended an antibiotic change in 25% of timeouts with 70% of recommended changes accepted by hospitalists. Barriers included unanticipated and weekend discharges. There were no differences in antibiotic use after discharge during the intervention compared to control services.
AHRQ-funded; HS026530.
Citation: Giesler DL, Krein S, Brancaccio A .
Reducing overuse of antibiotics at discharge home: a single-center mixed methods pilot study.
Am J Infect Control 2022 Jul;50(7):777-86. doi: 10.1016/j.ajic.2021.11.016..
Keywords: Antibiotics, Antimicrobial Stewardship, Medication, Hospital Discharge, Transitions of Care
Vaughn VM, Hersh AL, Spivak ES
Antibiotic overuse and stewardship at hospital discharge: the reducing overuse of antibiotics at discharge home framework.
In this review, the authors discussed what is currently known about antibiotic overuse at hospital discharge, key barriers, and targets for improving antibiotic prescribing at discharge. They introduced an evidence-based framework, the Reducing Overuse of Antibiotics at Discharge Home Framework, for conducting discharge antibiotic stewardship.
AHRQ-funded; HS026530.
Citation: Vaughn VM, Hersh AL, Spivak ES .
Antibiotic overuse and stewardship at hospital discharge: the reducing overuse of antibiotics at discharge home framework.
Clin Infect Dis 2022 May 3;74(9):1696-702. doi: 10.1093/cid/ciab842..
Keywords: Antimicrobial Stewardship, Antibiotics, Medication, Hospital Discharge, Hospitals
Chiotos K, Fitzgerald JC, Hayes M
Improving vancomycin stewardship in critically ill children.
The purpose of this study was to describe a quality improvement intervention to reduce the use of vancomycin in a tertiary care Pediatric Intensive Care Unit. Over a period of 3 years, the researchers conducted 3 quality improvement (QI) interventions including 1) stakeholder education, 2) development of a consensus-based guideline for empiric vancomycin use, and 3) implementation of the guideline through clinical decision support. The study found that of 1276 episodes of suspected bacterial infection, a total of 19 cases of bacteremia (1.5%) due to organisms requiring vancomycin therapy were identified, including 6 MRSA bacteremias. Over the 3-year period of the QI project, overall vancomycin DOT per 1000 patient days in the PICU decreased from a baseline mean of 182 DOT per 1000 patient days to 109 DOT per 1000 patient days (a 40% reduction). The study concluded that the intervention reduced overall vancomycin use in the Pediatric Intensive Care Unit without evidence of harm.
AHRQ-funded; HS026393.
Citation: Chiotos K, Fitzgerald JC, Hayes M .
Improving vancomycin stewardship in critically ill children.
Pediatrics 2022 Apr;149(4):e2021052165. doi: 10.1542/peds.2021-052165..
Keywords: Children/Adolescents, Critical Care, Antimicrobial Stewardship, Antibiotics, Medication, Intensive Care Unit (ICU)
Sharara SL, Arbaje AI, Cosgrove SE
The voice of the patient: patient roles in antibiotic management at the hospital-to-home transition.
The objective of this study was to characterize tasks required for patient-performed antibiotic medication management (MM) at the hospital-to-home transition, as well as barriers to and strategies for patient-led antibiotic MM. The overall goal was to understand patients' role in managing antibiotics at the hospital-to-home transition. The investigators concluded that there are many opportunities to improve patient-led antibiotic MM at the hospital-to-home transition.
AHRQ-funded; HS026995.
Citation: Sharara SL, Arbaje AI, Cosgrove SE .
The voice of the patient: patient roles in antibiotic management at the hospital-to-home transition.
J Patient Saf 2022 Apr 1;18(3):e633-e39. doi: 10.1097/pts.0000000000000899..
Keywords: Antibiotics, Antimicrobial Stewardship, Medication, Hospital Discharge, Transitions of Care, Patient Self-Management
Sun DS, Kissler SM, Kanjilal S
Analysis of multiple bacterial species and antibiotic classes reveals large variation in the association between seasonal antibiotic use and resistance.
The purpose of this study was to evaluate the relationship between the seasonal use of 5 classes of antibiotics (penicillins, macrolides, quinolones, tetracyclines, and nitrofurans) and antibiotic resistance across 3 species of bacteria: Staphylococcus aureus, Escherichia coli, and Klebsiella pneumoniae. The study found seasonal peaks in use which varied by class, with resistance in all 9 species-antibiotic combinations peaking in the spring and winter. Resistance to all antibiotic classes had the highest correlation with the use of the macrolides and penicillins which were the winter peaking classes. The researchers concluded that antibiotic use strategies will not be equally effective across all species and all antibiotics, but instead selection for resistance across antibiotic classes may be governed by penicillins and macrolides, the most commonly prescribed classes of antibiotics.
AHRQ-funded; HS027841.
Citation: Sun DS, Kissler SM, Kanjilal S .
Analysis of multiple bacterial species and antibiotic classes reveals large variation in the association between seasonal antibiotic use and resistance.
PLoS Biol 2022 Mar;20(3):e3001579. doi: 10.1371/journal.pbio.3001579..
Keywords: Antibiotics, Antimicrobial Stewardship, Medication
Olsen MA, Greenberg JK, Peacock K
Lack of association of post-discharge prophylactic antibiotics with decreased risk of surgical site infection following spinal fusion.
This study’s objective was to determine the prevalence and factors associated with post-discharge prophylactic antibiotic use after spinal fusion and whether use was associated with decreased risk of surgical site infection (SSI). The study cohort included persons aged 10-64 years undergoing 156,446 spinal fusion procedures between January 2010 and July 2015. Excluded patients included complicated cases and those coded for infection from 30 days before to 2 days after surgical admission. Outpatient oral antibiotic prescriptions were identified within 2 days of surgical discharge. ICD-9-CM diagnosis codes were used to identify SSI within 90 days of surgery. Post-discharge prophylactic antibiotics were used in 9223 surgeries. SSIs occurred after 2557 procedures (1.6%). Factors significantly associated with post-discharge antibiotic use included history of lymphoma, diabetes, 3-7 versus 1-2 vertebral levels fused, and non-infectious postoperative complications. Analysis showed antibiotic use was not associated with decreased SSI risk after spinal fusion.
AHRQ-funded; HS019455; HS027075.
Citation: Olsen MA, Greenberg JK, Peacock K .
Lack of association of post-discharge prophylactic antibiotics with decreased risk of surgical site infection following spinal fusion.
J Antimicrob Chemother 2022 Mar 31;77(4):1178-84. doi: 10.1093/jac/dkab475..
Keywords: Antibiotics, Medication, Surgery, Antimicrobial Stewardship, Practice Patterns
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
Nielsen TB, Santarossa M, Probst B
Introducing antimicrobial stewardship to the outpatient clinics of a suburban academic health system.
This study’s objective was to determine attitudes of prescribers of antimicrobials to help establish an antimicrobial stewardship program in the outpatient setting. Participants included prescribers at Loyola University Health System, an academic teaching healthcare system with 19 primary care and 3 intermediate- and urgent-care clinics. A voluntary survey was developed using SurveyMonkey and was distributed via email. Data were conducted anonymously. Three metrics were assessed for rates of compliance and included: (1) avoidance of antibiotics in adult acute bronchitis and appropriate antibiotic treatment in (2) patients tested for pharyngitis and (3) children with upper respiratory tract infections. Prescribers were very knowledgeable about what constitutes appropriate prescribing, but fewer than half believed antibiotics were overprescribed in their office. The respondents reported that 74% received intense pressure from patients to prescribe antimicrobials inappropriately. Intermediate- and urgent-care prescribers had higher rates of compliance than primary-care prescribers. However, the latter group responded well to monthly reports and online educational resources.
AHRQ-funded; HS025690.
Citation: Nielsen TB, Santarossa M, Probst B .
Introducing antimicrobial stewardship to the outpatient clinics of a suburban academic health system.
Antimicrob Steward Healthc Epidemiol 2022;2(1):e9. doi: 10.1017/ash.2021.228..
Keywords: Antimicrobial Stewardship, Antibiotics, Medication, Ambulatory Care and Surgery
Li LX, Szymczak JE, Keller SC
Antibiotic stewardship in direct-to-consumer telemedicine: translating interventions into the virtual realm.
This article discusses using the core elements for outpatient antibiotic stewardship as a framework for direct-to-consumer (DTC) telemedicine. There is limited scholarship regarding adapting and implementing antibiotic stewardship principles in this setting. The authors discussed utilizing the core elements for outpatient antibiotic stewardship as a framework for efforts moving forward.
AHRQ-funded; HS027819.
Citation: Li LX, Szymczak JE, Keller SC .
Antibiotic stewardship in direct-to-consumer telemedicine: translating interventions into the virtual realm.
J Antimicrob Chemother 2021 Dec 24;77(1):13-15. doi: 10.1093/jac/dkab371..
Keywords: Antibiotics, Antimicrobial Stewardship, Medication, Telehealth, Health Information Technology (HIT)
Vaughn VM, Gandhi TN, Chopra V
Antibiotic overuse after hospital discharge: a multi-hospital cohort study.
Antibiotics are commonly prescribed to patients as they leave the hospital. In this study, the investigators aimed to create a comprehensive metric to characterize antibiotic overuse after discharge among hospitalized patients treated for pneumonia or urinary tract infection (UTI) and determine whether overuse varied across hospitals and conditions. The investigators concluded that antibiotic overuse after discharge was common and varied widely between hospitals.
AHRQ-funded; HS026530.
Citation: Vaughn VM, Gandhi TN, Chopra V .
Antibiotic overuse after hospital discharge: a multi-hospital cohort study.
Clin Infect Dis 2020 Dec 6;73(11):e4499-e506. doi: 10.1093/cid/ciaa1372..
Keywords: Antibiotics, Antimicrobial Stewardship, Medication, Hospital Discharge
Moehring RW, Ashley ESD, Davis AE
Development of an electronic definition for de-escalation of antibiotics in hospitalized patients.
The authors defined antibiotic de-escalation as reduction in either the number of antibiotics or spectrum rank and performed a retrospective study among 5 hospitals. They found that their electronic de-escalation metric demonstrated variation among hospitals, units, and diagnoses. They suggested that their metric may be useful for assessing stewardship opportunities and impact.
AHRQ-funded; HS023866.
Citation: Moehring RW, Ashley ESD, Davis AE .
Development of an electronic definition for de-escalation of antibiotics in hospitalized patients.
Clin Infect Dis 2021 Dec 6;73(11):e4507-e14. doi: 10.1093/cid/ciaa932..
Keywords: Antimicrobial Stewardship, Antibiotics, Medication, Inpatient Care
Goodman KE, Pineles L, Magder LS
Electronically available patient claims data improve models for comparing antibiotic use across hospitals: results from 576 U.S. facilities.
This study’s goal was to identify comorbidities causally related to appropriate antibiotic use and to compare seven models that include these comorbidities and other patient-level claims variables to a facility model for risk-adjusting inpatient antibiotic utilization. Subjects included adults discharged from Premier Database hospitals in 2016-2017. Findings showed that adding electronically available patient claims data to facility models consistently improved antibiotic utilization predictions and yielded substantial movement in hospitals' utilization rankings.
AHRQ-funded; HS026205.
Citation: Goodman KE, Pineles L, Magder LS .
Electronically available patient claims data improve models for comparing antibiotic use across hospitals: results from 576 U.S. facilities.
Clin Infect Dis 2021 Dec 6;73(11):e4484-e92. doi: 10.1093/cid/ciaa1127..
Keywords: Antibiotics, Antimicrobial Stewardship, Hospitals
Clark AW, Durkin MJ, Olsen MA
Rural-urban differences in antibiotic prescribing for uncomplicated urinary tract infection.
This study examined rural-urban differences in temporal trends and risk of inappropriate antibiotic use by agent and duration among women with uncomplicated urinary tract infection (UTI). This observational cohort study identified US commercially insured women aged 18-44 coded for uncomplicated UTI and prescribed an antibiotic from the IBM MarketScan Commercial Database (2010-2015). Of the 670,450 women with uncomplicated UTIs, a large proportion received antibiotic prescriptions for inappropriate agents (46.7%) or durations (76.1%). Rural women were more likely to receive prescriptions with inappropriately long durations than urban women. There was a slight decline in patients who received inappropriate agents and durations from 2011 to 2015. Rural-urban differences varied over time by agent, geographic region, and provider specialty.
AHRQ-funded; HS019455.
Citation: Clark AW, Durkin MJ, Olsen MA .
Rural-urban differences in antibiotic prescribing for uncomplicated urinary tract infection.
Infect Control Hosp Epidemiol 2021 Dec;42(12):1437-44. doi: 10.1017/ice.2021.21..
Keywords: Antimicrobial Stewardship, Antibiotics, Medication, Urinary Tract Infection (UTI), Practice Patterns
Moehring RW, Yarrington ME, Davis AE
Effects of a collaborative, community hospital network for antimicrobial stewardship program implementation.
The authors investigated expertise, data resources, and educational tools to support antimicrobial stewardship programs (ASP) in hospitals. They found that network hospitals increased ASP activities and demonstrated decline in antimicrobial use over the 42-month study period. They concluded that their collaborative, consultative network proved a unique model in which hospitals can access ASP implementation expertise to support long-term program growth.
AHRQ-funded; HS023866.
Citation: Moehring RW, Yarrington ME, Davis AE .
Effects of a collaborative, community hospital network for antimicrobial stewardship program implementation.
Clin Infect Dis 2021 Nov 2;73(9):1656-63. doi: 10.1093/cid/ciab356..
Keywords: Antimicrobial Stewardship, Antibiotics, Hospitals, Implementation, Medication
Richards AR, Linder JA
Behavioral economics and ambulatory antibiotic stewardship: a narrative review.
Behavioral economics recognizes that contextual, psychological, social, and emotional factors powerfully influence decision-making. Behavioral economics has the potential to provide a better understanding of, and, through subtle environmental changes, or "nudges," improve persistent quality-of-care challenges, like ambulatory antibiotic overprescribing. In this study, the investigators conducted a Medline search and performed a narrative review that examined the use of behavioral economics to understand the rationale for, and improvement of, ambulatory antibiotic prescribing.
AHRQ-funded; 2332015000201; HS026506; HS028127.
Citation: Richards AR, Linder JA .
Behavioral economics and ambulatory antibiotic stewardship: a narrative review.
Clin Ther 2021 Oct;43(10):1654-67. doi: 10.1016/j.clinthera.2021.08.004..
Keywords: Antimicrobial Stewardship, Antibiotics, Practice Patterns, Respiratory Conditions
Fischer MA, Mahesri M, Lii J
Non-visit-based and non-infection-related antibiotic use in the US: a cohort study of privately insured patients during 2016-2018.
Ambulatory antibiotic prescriptions without a clinic visit or without documentation of infection could represent overuse and contribute to adverse outcomes. We aim to describe US ambulatory antibiotic prescribing, including those without an associated visit or infection diagnosis. The investigators conducted an observational cohort study using data of all patients receiving antibacterial, antibiotic prescriptions from 04/01/2016 to 06/30/2018 in a large US private health insurance plan. They concluded that over half of ambulatory antibiotic use was either non-visit-based or non-infection-related.
AHRQ-funded; HS02493.
Citation: Fischer MA, Mahesri M, Lii J .
Non-visit-based and non-infection-related antibiotic use in the US: a cohort study of privately insured patients during 2016-2018.
Open Forum Infect Dis 2021 Sep;8(9):ofab412. doi: 10.1093/ofid/ofab412..
Keywords: Antibiotics, Medication, Antimicrobial Stewardship
Chua KP, Linder JA
Prevalence of inappropriate antibiotic prescribing by antibiotic among privately and publicly insured non-elderly US patients, 2018.
The authors used 2018 commercial and Medicaid claims to assess inappropriate prescribing of antibiotics. In their analysis, 22% of antibiotic claims were inappropriate. Azithromycin had an outsized role in inappropriate prescribing. They concluded that broad-based stewardship initiatives remain important given widespread inappropriate prescribing of all antibiotics.
AHRQ-funded; HS024930; HS026506; 2332015000201.
Citation: Chua KP, Linder JA .
Prevalence of inappropriate antibiotic prescribing by antibiotic among privately and publicly insured non-elderly US patients, 2018.
J Gen Intern Med 2021 Sep;36(9):2861-64. doi: 10.1007/s11606-020-06189-z..
Keywords: Antibiotics, Antimicrobial Stewardship, Medication, Medicaid, Health Insurance
Goodman KE, Cosgrove SE, Pineles L
Significant regional differences in antibiotic use across 576 US hospitals
This study’s objective was to examine adult antibiotic use across 576 hospitals and nearly 12 million encounters in 2016-2017. Findings showed that adult inpatient antibiotic use remained high, driven predominantly by broad-spectrum agents. Recommendations included better understanding of the reasons for interhospital usage differences, including by region and teaching status, in order to inform efforts to reduce inappropriate antibiotic prescribing.
AHRQ-funded; HS026205.
Citation: Goodman KE, Cosgrove SE, Pineles L .
Significant regional differences in antibiotic use across 576 US hospitals
Significant regional differences in antibiotic use across 576 US hospitals and 11 701 326 adult admissions, 2016-2017..
Keywords: Antimicrobial Stewardship, Antibiotics, Medication, Hospitals
Carayon P, Thuemling T, Parmasad V
Implementation of an antibiotic stewardship intervention to reduce prescription of fluoroquinolones: a human factors analysis in two intensive care units.
In this study, researchers conducted an in-depth analysis of an intervention aimed at limiting ICU prescriber access to fluoroquinolones (FQ) in the ICUs of two hospitals. Their results showed some differences in the implementation of the FQ intervention between the two studied ICUs, such as level and method of FQ restriction, and training and communication with physicians and pharmacists. In both ICUs, several organizational learning mechanisms helped quickly to identify problems with the intervention and to ensure that changes were made in a just-in-time manner. Despite their organizational differences, both sites developed strategies to implement the FQ intervention successfully.
AHRQ-funded; HS026226.
Citation: Carayon P, Thuemling T, Parmasad V .
Implementation of an antibiotic stewardship intervention to reduce prescription of fluoroquinolones: a human factors analysis in two intensive care units.
J Patient Saf Risk Manag 2021 Jul;26(4):161-71..
Keywords: Antimicrobial Stewardship, Antibiotics, Medication, Intensive Care Unit (ICU)
Safdar N, Parmasad V, Brown R
Decreasing ICU-associated Clostridioides difficile infection through fluoroquinolone restriction, the FIRST trial: a study protocol.
Clostridioides difficile infection (CDI) is one of the most common healthcare-associated infections in the USA, having high incidence in intensive care units (ICU). Antibiotic use increases risk of CDI, with fluoroquinolones (FQs) particularly implicated. In healthcare settings, antibiotic stewardship (AS) and infection control interventions are effective in CDI control, but there is little evidence regarding the most effective AS interventions. In this paper the investigators describe their multisite, stepped-wedge, cluster, effectiveness-implementation clinical trial.
AHRQ-funded; R01 HS026226.
Citation: Safdar N, Parmasad V, Brown R .
Decreasing ICU-associated Clostridioides difficile infection through fluoroquinolone restriction, the FIRST trial: a study protocol.
BMJ Open 2021 Jun 29;11(6):e046480. doi: 10.1136/bmjopen-2020-046480..
Keywords: Clostridium difficile Infections, Healthcare-Associated Infections (HAIs), Intensive Care Unit (ICU), Antimicrobial Stewardship, Antibiotics, Medication, Prevention