Background
What is InPART Rx?
A collaborative research study to measure the impact of a planned quality improvmenet inititaitve to reduce unceccessary antibiotic prescribing by Hospital Medicine Service through a process of receiving peer-comparison summary prescribing data bimonthly.
The initiative is a collaboration between EHC Pharmacy, SOM Division of Infectious Diseases, and SOM Hopistal Medicine, ramping up to launch in early 2023.
Approximately 50% of hospitalized patients receive an antibiotic during their stay. Of these, an estimated 30% were either unnecessary or prescribed incorrectly.
Synopsis
Starting in 2023 hospitalists at EUH, EUHM, ESJH, and EJCH will receive a personalized report of broad-spectrum antibiotic prescribing, with comparisons to their peers. These reports will help individuals recognize to what degree they can reduce unnecessary prescribing of agents such as piperacillin/tazobactam or meropenem.
The reports will be produced every two months along with messaging and coaching on actions they can take to improve prescribing. Investigators will study the impact of these reports on prescribing patterns and check on key patient-safety outcomes during the study to ensure best patient care continues throughout the quality improvement initiative.
Justification
Hospitalists care for newly admitted patients and those transitioning from critical and long term care, and frequently prescribe antibiotics for common inpatient problems (e.g., urinary tract infection, pneumonia). Recent studies of antibiotic prescribing data for these conditions suggest opportunities to improve prescribing accuracy.
In the ambulatory setting, there is substantial evidence that improving provider prescribing practices can be achieved by using peer feedback of prescribing rates for benchmarking. Emory Healthcare (EHC) through a Quality Initiative (QI) successfully used peer comparisons in the clinics.
Establishment of the Advisory Committee
In order to curate best possible peer-comparison metrics and educational messages, the Department of Hospital Medicine has agreed to form a formal EHC Hospital Medicine Antimicrobial Prescribing Advisory Committee. This committee will provide input on helpful approaches to education to help improve antibiotic prescribing and help champion the project.
Objectives of InPART Rx
Primary Objective:
- Determine the impact of using an automated peer comparison of antibiotic prescribing on hospitalists prescribing rates
Secondary Objectives:
- Demonstrate no adverse effects on patients cared for by HMS during study period
- Determine variability and predictors of antibiotic prescribing by Hospital Medicine Service (HMS) across four Emory Healthcare Hospitals
Who We Are
The Emory HAI Prevention Epicenter: The official program is named The Prevention Epicenter of Emory and Collaborating Healthcare Facilities (PEACH II), a 5-year CDC-funded program addressing healthcare-associated infections caused by multidrug-resistant organisms (MDROs) across the healthcare delivery spectrum.
PEACH includes a portfolio of research that can influence or change standard practices and fill gaps in current infection prevention guidance. Projects advance transdisciplinary research incorporating human factors engineering, microbiome therapeutics, environmental microbiology, and bioinformatics.
InPART Rx Study Details
Design
We will employ a quasi-experimental before-after study design, using a stepped wedge approach with 4 hospitals. Study participants will include all ~150 full-time hospitalists. The intervention will be rolled out sequentially to all 4 hospitals in 3-month intervals. The intervention will last 18 months at all 4 sites.
Enrollment
Facilities (EHC Entity) will be randomized to order of implementation roll out of intervention (INT), or continue baseline (BSLINE) usual care
Study Timeline
- Fall 2022 - Approvals and Socialization of the QI initiative with HMS
- Fall 2022 - Refine baseline analysis and regression modeling completion
- Fall 2022 - Create bimonthly feedback report
- January-March 2023 - Roll out intervention
- January-March 2024 - Data and safety monitoring, interim evaluation with HMS leadership
- Fall 2024 - Final analysis and internal discussions on maintinng intervention or modification
- January 2025 - Publication of results
Investigative Team
Scott K. Fridkin, MD
Department of Medicine, Division of Infectious Diseases
sfridki@emory.edu
Ray Dantes, MD, MPH
Division of Hospital Medicine
raymund.dantes@emoryhealthcare.org
Ashley Jones, Dr.Pharm
Emory Healthcare, Department of Pharmacy
kayla.jones@emoryhealthcare.org
