The Effect of Audit-and-feedback on the Excessive Use of Post-procedural Antimicrobials in Urologic Patients: a Pilot Intervention Study
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 发起方
- 入组人数
- 525
- 试验地点
- 5
- 主要终点
- Percentage of Cases Who Received Excessive Post-procedural Antimicrobials
研究概览
简要总结
Antimicrobial resistance is one of today''s most urgent public health problems. An important strategy to slow the spread of antimicrobial resistance is the promotion of judicious antimicrobial use. There are many opportunities to reduce unnecessary antimicrobial-prescribing, including in patients undergoing surgical procedures. The following study will specifically study opportunities to improve antimicrobial use in patients undergoing common urologic procedures at hospitals in the Veterans Health Administration (VHA).
Guidelines recommend giving antibiotics for no more than 24-hours after most urologic procedures, but the investigators have shown that the unnecessary use of post-procedural antimicrobials is common in this setting. In a national cohort of nearly 30,000 VHA patients, excessive post-procedural antimicrobials were prescribed after 37.2% of urologic procedures for a median duration of 3.0 excess days.
In this study, the investigators will evaluate whether giving regular feedback to providers at 3 VHA hospitals can reduce unnecessary antimicrobial use after urologic procedures.
详细描述
Trial design: The investigators propose a before/after quasi-experimental design, which will be analyzed with an interrupted time-series analysis.
Participants: There will be 3 intervention VHA hospitals. To be eligible, a VHA hospital must perform the following 3 urologic procedures: transurethral resection of the prostate (TURP), transurethral resection of a bladder tumor (TUBRT), and ureteroscopy (URS).
Interventions: The study team will conduct an audit-and-feedback intervention focused on the unnecessary use of prolonged antimicrobial therapy after common urologic procedures.
The audit-and-feedback intervention will target the urology providers at the 3 intervention sites.
Outcomes: The primary outcome for this study will be the frequency of excessive post-procedural antimicrobial-prescribing in the 3 urologic procedures of interest. Secondary outcomes include several safety outcomes, such as late antimicrobial prescriptions, return visits, mortality, C. difficile testing and C. difficile infection.
研究设计
- 研究类型
- Interventional
- 分配方式
- Na
- 干预模型
- Single Group
- 主要目的
- Health Services Research
- 盲法
- None
入排标准
- 性别
- All
- 接受健康志愿者
- 是
入选标准
- •A practicing urologist at an intervention site, OR
- •A member of the antimicrobial stewardship team at an intervention site
排除标准
- 未提供
研究组 & 干预措施
Intervention
We will randomly select 3 intervention sites from the top quartile of all VHA sites, as ranked by the frequency of excessive post-procedural antimicrobial use after the 3 urologic procedures of interest. We will provide feedback both at baseline and at regular intervals to the 3 intervention sites. Data on hospital-level excessive post-procedural antimicrobial use specific to urologic patients (primary outcome) will be shared at baseline with the intervention sites. Updated data will be sent electronically to urology providers and the antimicrobial stewardship team at the intervention site every other month via electronic mail. These data will include an anonymous comparison to all other VHA hospitals.
干预措施: Audit-and-feedback (Behavioral)
结局指标
主要结局
Percentage of Cases Who Received Excessive Post-procedural Antimicrobials
时间窗: Within 1 day of the urologic procedure
Excessive post-procedural antimicrobial use is defined as a prescription for a antimicrobial agent on post-procedural day one. For this specific outcome measure, the numerator will be the number of patients who received an excessive post-procedural antimicrobial, and the denominator will be all patients at the site who underwent a qualifying urologic procedure.
次要结局
- Excessive Post-procedural Antimicrobial Duration (Mean)(Within 30-days of the urologic procedure)
- Percentage of Cases Who Received a Late Antimicrobial Prescription(Within 30-days of the urologic procedure)
- Percentage of Cases Who Were Re-admitted to the Hospital or Presented to an Emergency Department or an Urgent Care Clinic(Within 30-days of the urologic procedure)
- Percentage of Cases Who Died (Mortality)(Within 30-days of the urologic procedure)
- Percentage of Cases Who Underwent Clostridioides Difficile Testing(Within 30-days of the urologic procedure)
- Percentage of Cases Who Acquired Clostridioides Difficile Infection(Within 30-days of the urologic procedure)
研究者
Daniel Livorsi
Principal investigator
Iowa City Veterans Affairs Medical Center