National Healthcare Quality and Disparities Report
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Search All Research Studies
Topics
- Adverse Events (1)
- Antibiotics (12)
- (-) Antimicrobial Stewardship (14)
- Asthma (1)
- Children/Adolescents (1)
- Chronic Conditions (1)
- Community-Acquired Infections (2)
- COVID-19 (1)
- Critical Care (1)
- Education: Patient and Caregiver (1)
- Electronic Health Records (EHRs) (1)
- Healthcare-Associated Infections (HAIs) (2)
- Healthcare Costs (1)
- Health Information Technology (HIT) (1)
- Health Literacy (1)
- Health Services Research (HSR) (1)
- Hospital Discharge (1)
- Hospitals (1)
- Inpatient Care (1)
- Maternal Care (1)
- Medication (12)
- Methicillin-Resistant Staphylococcus aureus (MRSA) (1)
- Pneumonia (4)
- Practice Patterns (4)
- Pregnancy (1)
- Primary Care (3)
- Public Health (1)
- Quality of Care (1)
- (-) Respiratory Conditions (14)
- Skin Conditions (1)
- Urinary Tract Infection (UTI) (1)
- Women (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 14 of 14 Research Studies DisplayedDeshpande A, Walker R, Schulte R
Reducing antimicrobial overuse through targeted therapy for patients with community-acquired pneumonia: a study protocol for a cluster-randomized factorial controlled trial (CARE-CAP).
The authors described a planned cluster-randomized controlled trial in 12 hospitals in the Cleveland Clinic Health System to test two approaches to reducing the use of extended-spectrum antibiotics (ESA) in adult patients with community-acquired pneumonia (CAP): rapid diagnostic assays that provide accurate results within hours, and de-escalation after negative bacterial cultures in clinically stable patients. The purpose will be to establish whether the identification of an etiological agent early and pharmacist-led de-escalation can safely reduce the use of ESA in patients with CAP. The findings may also inform clinical guidelines on the management of CAP.
AHRQ-funded; HS028633.
Citation: Deshpande A, Walker R, Schulte R .
Reducing antimicrobial overuse through targeted therapy for patients with community-acquired pneumonia: a study protocol for a cluster-randomized factorial controlled trial (CARE-CAP).
Trials 2023 Sep 16; 24(1):595. doi: 10.1186/s13063-023-07615-3..
Keywords: Antibiotics, Antimicrobial Stewardship, Medication, Community-Acquired Infections, Pneumonia, Respiratory Conditions
Soper NS, Appukutty AJ, Paje D
Antibiotic overuse after discharge from medical short-stay units.
This study investigated antibiotic overuse after discharge from medical short-stay units (SSUs). This cross-sectional study included patients hospitalized in 2 different medical SSUs with a total of 40 beds at a single academic medical center. Eligible adults were discharged with an oral antibiotic from either SSU from May 2018 to September 2019. Of 100 patients discharged from SSUs with antibiotics, 47 had a skin and soft-tissue infection (SSTI), 22 pneumonia, 21 UTI, and 10 had “other” infections. Overall, 78 cases (78%) were defined as overuse, including 39 of 47 of those treated for SSTI, 17 of 21 for UTI, and 14 of 22 for pneumonia. The most common types of overuse were excess duration and guideline discordant selection. Examples of factors influencing overuse included consultant recommendations, miscalculation of duration, and the need for source control procedure.
AHRQ-funded; HS026530.
Citation: Soper NS, Appukutty AJ, Paje D .
Antibiotic overuse after discharge from medical short-stay units.
Nov;43(11):1689-92. doi: 10.1017/ice.2021.346..
Keywords: Antibiotics, Antimicrobial Stewardship, Medication, Pneumonia, Skin Conditions, Urinary Tract Infection (UTI), Respiratory Conditions, Hospital Discharge
Snyder BM, Patterson MF, Gebretsadik T
Association between asthma status and prenatal antibiotic prescription fills among women in a Medicaid population.
The objective of this study was to assess the relationship between maternal asthma and outpatient prenatal antibiotic prescription fills to inform antibiotic stewardship. With data from the Tennessee Medicaid Program, findings showed that women with asthma had an increased risk of filling at least one prenatal antibiotic prescription and had an increased number of fills during pregnancy compared to women without asthma. These findings highlight that pregnant women with asthma disproportionately fill more antibiotic prescriptions during pregnancy.
AHRQ-funded; HS018454.
Citation: Snyder BM, Patterson MF, Gebretsadik T .
Association between asthma status and prenatal antibiotic prescription fills among women in a Medicaid population.
J Asthma 2022 Oct;59(10):2100-07. doi: 10.1080/02770903.2021.1993247..
Keywords: Asthma, Respiratory Conditions, Pregnancy, Antibiotics, Antimicrobial Stewardship, Medication, Maternal Care, Women, Chronic Conditions
Vaughn VM, Gandhi TN, Hofer TP
A statewide collaborative quality initiative to improve antibiotic duration and outcomes in patients hospitalized with uncomplicated community-acquired pneumonia.
Researchers sought to improve antibiotic duration for community-acquired pneumonia (CAP) across 41 hospitals participating in the Michigan Hospital Medicine Safety Consortium (HMS). They found that, across diverse hospitals, HMS participation was associated with more appropriate use of short-course therapy and fewer adverse events in hospitalized patients with uncomplicated CAP.
AHRQ-funded; HS026530.
Citation: Vaughn VM, Gandhi TN, Hofer TP .
A statewide collaborative quality initiative to improve antibiotic duration and outcomes in patients hospitalized with uncomplicated community-acquired pneumonia.
Clin Infect Dis 2022 Aug 31;75(3):460-67. doi: 10.1093/cid/ciab950..
Keywords: Community-Acquired Infections, Pneumonia, Antibiotics, Antimicrobial Stewardship, Medication, Respiratory Conditions
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
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
Deshpande A, Richter SS, Haessler S
De-escalation of empiric antibiotics following negative cultures in hospitalized patients with pneumonia: rates and outcomes.
This study assessed antibiotic de-escalation practices across hospitals and their associations with outcomes in hospitalized patients diagnosed with pneumonia with negative cultures. The authors included 14,170 adults admitted with pneumonia in 2010-2015 to 164 US hospitals if they had negative blood and/or respiratory cultures and received both anti-MRSA and antipseudomonal agents other than quinolones. If empiric drugs were stopped on day 4 while continuing another antibiotic it was defined at de-escalation. Patients were propensity adjusted for de-escalation and compared on in-hospital 14-day mortality, late deterioration with ICU transfer, length-of-stay (LOS) and costs. Thirteen percent (1924 patients) had both initial empiric drugs stopped by hospital day 4. De-escalation rates at hospitals ranged from 2-35% and the established rate quartiles were not significantly associated with outcomes. Even at hospitals in the top quartile of de-escalation, the de-escalation rates were lower than 50%.
AHRQ-funded; HS025026; HS024277.
Citation: Deshpande A, Richter SS, Haessler S .
De-escalation of empiric antibiotics following negative cultures in hospitalized patients with pneumonia: rates and outcomes.
Clin Infect Dis 2021 Apr 26;72(8):1314-22. doi: 10.1093/cid/ciaa212..
Keywords: Antimicrobial Stewardship, Antibiotics, Medication, Pneumonia, Respiratory Conditions, Methicillin-Resistant Staphylococcus aureus (MRSA), Healthcare-Associated Infections (HAIs), Inpatient Care
Truitt KN, Brown T, Lee JY
Appropriateness of antibiotic prescribing for acute sinusitis in primary care: a cross-sectional study.
The proportion of sinusitis visits that meet antibiotic prescribing criteria is unknown. In this cross-sectional study the authors investigated the appropriateness of antibiotic prescribing for acute sinusitis in primary care. The investigators found that of 425 randomly selected sinusitis visits, 50% met antibiotic prescribing criteria.
AHRQ-funded; HS024930; 233201500020I; HS026506.
Citation: Truitt KN, Brown T, Lee JY .
Appropriateness of antibiotic prescribing for acute sinusitis in primary care: a cross-sectional study.
Clin Infect Dis 2021 Jan 15;72(2):311-14. doi: 10.1093/cid/ciaa736..
Keywords: Antibiotics, Medication, Antimicrobial Stewardship, Primary Care, Respiratory Conditions, Practice Patterns
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
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
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
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
Gidengil CA, Linder JA, Beach S
Using clinical vignettes to assess quality of care for acute respiratory infections.
Overprescribing of antibiotics for acute respiratory infections (ARIs) is common. The objective of this study was to develop and validate a vignette-based method to estimate clinician ARI antibiotic prescribing. The researchers concluded that responses to 3 clinical vignettes can identify clinicians with relatively poor quality ARI antibiotic prescribing. Vignettes may be a mechanism to target clinicians for quality improvement efforts.
AHRQ-funded; HS018419.
Citation: Gidengil CA, Linder JA, Beach S .
Using clinical vignettes to assess quality of care for acute respiratory infections.
Inquiry 2016 Apr 20;53:pii: 0046958016636531. doi: 10.1177/0046958016636531..
Keywords: Antibiotics, Antimicrobial Stewardship, Electronic Health Records (EHRs), Health Information Technology (HIT), Health Services Research (HSR), Medication, Practice Patterns, Primary Care, Quality of Care, Respiratory Conditions
Kelesidis T, Braykov N, Uslan DZ
Indications and types of antibiotic agents used in 6 acute care hospitals, 2009-2010: a pragmatic retrospective observational study.
This study characterized the indications for antibiotic therapy, agents used, duration, combinations, and microbiological justification in 6 acute-care US facilities with varied location, size, and type of antimicrobial stewardship programs. It concluded that the use of broad-spectrum empirical therapy was prevalent in 6 US acute care facilities. Fluoroquinolones, vancomycin, and antipseudomonal penicillins were the most frequently used antibiotics, particularly for respiratory indications
AHRQ-funded; HS021188.
Citation: Kelesidis T, Braykov N, Uslan DZ .
Indications and types of antibiotic agents used in 6 acute care hospitals, 2009-2010: a pragmatic retrospective observational study.
Infect Control Hosp Epidemiol 2016 Jan;37(1):70-9. doi: 10.1017/ice.2015.226.
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Keywords: Antimicrobial Stewardship, Critical Care, Hospitals, Medication, Respiratory Conditions