Feedback to Improve Rational Strategies of Antibiotic Initiation and Duration in Long Term
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 356
- 试验地点
- 2
- 主要终点
- Antibiotic initiation
研究概览
简要总结
There is a high rate of inappropriate antibiotic use in long-term care (LTC) facilities, with both unnecessary initiation and prolongation of treatments. Although there are challenges to rational antibiotic use in LTC, the variability in antibiotic initiation and use of prolonged treatment durations is driven by prescriber tendencies rather than resident characteristics. Audit-and-feedback is a well-established intervention to improve professional practices, and is ideally suited for use to improve antibiotic prescribing tendencies in LTC. The literature is saturated with trials indicating benefit of audit-and-feedback, but is in dire need of studies to identify methods to improve the impact of this technique. Health Quality Ontario (HQO), a key partner in the FIRST AID-LTC research program, is already providing audit-and-feedback for other inappropriate prescribing practices in LTC, and has identified antibiotic prescribing as a priority focus.
详细描述
Overarching Goals
The overarching goals of FIRST AID - LTC are two-fold:
- Improve rational antibiotic prescribing by physicians to minimize harms among LTC residents.
- Advance the science of audit-and-feedback to improve physician prescribing practices.
Specific Aims
To improve rational antibiotic prescribing in LTC:
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Treatment
- 盲法
- Triple (Participant, Investigator, Outcomes Assessor)
盲法说明
The team at Health Quality Ontario will be aware of the physicians' assignment to dynamic versus paginated reports so that they can send the correct audit-and-feedback document. However, the analytic team at ICES will be masked, and outcome data will be extracted by the analysis team from routinely collected administrative databases (Ontario drug benefits database).
入排标准
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •An individual having a minimum of 2 records on separate days within the quarter meeting any combination of the following criteria:
- •a record for a non-emergency long-term care inpatient services OR
- •an Ontario Drug Benefits record administered in long-term care
- •Index date = The analysis will be anchored on the most recent of either of the records above within a given quarter or their date of death (whichever date is earliest)
排除标准
- •Non-Ontario resident at index date
- •Invalid age (age<19 or age>115) at index date
- •Missing or invalid sex or date of birth at index date
- •Death date is >7 days before index date
- •If the individual does not live in a nursing home or home for the aged
- •Cannot be linked to a Most Responsible Physician (MRP) (see methodology below)
- •To Identify the Most Responsible Physician (MRP) Using Virtual Rostering
- •For each patient in the above resident cohort, the study team will retrieve all records from health care providers in the 6 month period preceding the index date (180 days), keeping only records from physicians who have a specialty of 1) general practice, 2) community medicine or 3) geriatrics.
- •Steps for MRP assignment:
- •Step 1) The study team will first select physicians with the highest count of records for the monthly management of a nursing home or home for the aged. This is completed for as many residents as possible.
- •Step 2) If there were no monthly management fee records as described above then the physician with highest count of non-emergency long-term care inpatient services records for each patient will be selected. This step is only applied to residents who could not be matched to a physician by Step
- •**Physician must have seen the patient one or more times in 90 days prior to and including index date to be considered MRP. This criteria is applied to ensure the physician has seen the resident within the reporting quarter.
- •Step 3) Some patients will virtually roster to physicians in Enrollment groups, some will virtually roster to physicians that are not in a group. For these, the study team will recode enrollment program type to 'NOR' (not otherwise rostered) - these are likely fee for service physicians.
结局指标
主要结局
Antibiotic initiation
时间窗: 3 months
Median % of patients initiated on an antibiotic
Antibiotic duration
时间窗: 3 months
Median % of antibiotic treatments prolonged \>7 days
次要结局
- ER visit or hospitalization for infection(3 months)
- ER visit or hospitalization for antibiotic harms(3 months)
- Net Clinical impact(3 months)
- Anti-psychotic use(3 months)
- Benzodiazepine use(3 months)
研究者
Nick Daneman
Adjunct Scientist
Institute for Clinical Evaluative Sciences