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Tu Y, Hsueh Y, Cheng Y, Lin T, Chiueh T. Objective indexes for comparing platelet usage among peer hospitals during the COVID-19 pandemic: A cross-sectional study. Health Sci Rep 2024; 7:e2032. [PMID: 38623389 PMCID: PMC11016628 DOI: 10.1002/hsr2.2032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 12/12/2023] [Accepted: 03/26/2024] [Indexed: 04/17/2024] Open
Abstract
Background and Aims Besides hospital size, clinical diagnosis and severity of patient cases determine the total platelet usage. Therefore, the appropriateness of platelet usage could not be compared simply with the total units of platelet usage in each hospital. This study aimed to objectively monitor and analyze platelet usage after implementing a single-unit issuing policy for each platelet transfusion in our hospital in October 2020. Materials and Methods We used three objective indices, X, Y, and Z, to monitor platelet usage and compared it with other hospitals. Three indices were generated by dividing the annual total units of platelet usage by the total annual reimbursement, total number of admissions, and average total reimbursement per admission for each hospital. Results The new indices X and Y alleviated hospital size-dependent differences. Index Y was preferred over X because its value fluctuated less during the COVID-19 pandemic. The Z index was adjusted for the average total reimbursement per admission, and the results showed that more patients with higher disease complexity did not have increased platelet usage during the COVID-19 pandemic. In our hospital (H1), index Z decreased from 2019 to 2021 due to a policy of issuing a single unit for each platelet transfusion. Conclusion These three objective indices are suitable for peer comparison and monitoring platelet usage in hospitals, irrespective of their size. They could be applied to promote patient blood management and provide an early response to the gradual shortage of blood resources owing to the aging population and declining birth rate in Taiwan.
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Affiliation(s)
- Ya‐Chi Tu
- Department of Laboratory MedicineNew Taipei Municipal Tu Cheng Hospital (Built and Operated by Chang Gung Medical Foundation)New Taipei CityTaiwan
| | - Yu‐Shan Hsueh
- Department of Laboratory MedicineLin‐Kou Chang Gung Memorial HospitalTaoyuanTaiwan
- College of MedicineChang Gung UniversityTaoyuanTaiwan
| | - Yu‐Chen Cheng
- Department of Laboratory MedicineNew Taipei Municipal Tu Cheng Hospital (Built and Operated by Chang Gung Medical Foundation)New Taipei CityTaiwan
| | - Ting‐Wei Lin
- Department of Laboratory MedicineLin‐Kou Chang Gung Memorial HospitalTaoyuanTaiwan
| | - Tzong‐Shi Chiueh
- Department of Laboratory MedicineLin‐Kou Chang Gung Memorial HospitalTaoyuanTaiwan
- College of MedicineChang Gung UniversityTaoyuanTaiwan
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2
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Meeker D, Friedberg MW, Knight TK, Doctor JN, Zein D, Cayasso-McIntosh N, Goldstein NJ, Fox CR, Linder JA, Persell SD, Dea S, Giboney P, Yee HF. Effect of Peer Benchmarking on Specialist Electronic Consult Performance in a Los Angeles Safety-Net: a Cluster Randomized Trial. J Gen Intern Med 2022; 37:1400-1407. [PMID: 34505234 PMCID: PMC8428492 DOI: 10.1007/s11606-021-07002-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 06/24/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Since the advent of COVID-19, accelerated adoption of systems that reduce face-to-face encounters has outpaced training and best practices. Electronic consultations (eConsults), structured communications between PCPs and specialists regarding a case, have been effective in reducing face-to-face specialist encounters. As the health system rapidly adapts to multiple new practices and communication tools, new mechanisms to measure and improve performance in this context are needed. OBJECTIVE To test whether feedback comparing physicians to top performing peers using co-specialists' ratings improves performance. DESIGN Cluster-randomized controlled trial PARTICIPANTS: Eighty facility-specialty clusters and 214 clinicians INTERVENTION: Providers in the feedback arms were sent messages that announced their membership in an elite group of "Top Performers" or provided actionable recommendations with feedback for providers that were "Not Top Performers." MAIN MEASURES The primary outcomes were changes in peer ratings in the following performance dimensions after feedback was received: (1) elicitation of information from primary care practitioners; (2) adherence to institutional clinical guidelines; (3) agreement with peer's medical decision-making; (4) educational value; (5) relationship building. KEY RESULTS Specialists showed significant improvements on 3 of the 5 consultation performance dimensions: medical decision-making (odds ratio 1.52, 95% confidence interval 1.08-2.14, p<.05), educational value (1.86, 1.17-2.96) and relationship building (1.63, 1.13-2.35) (both p<.01). CONCLUSIONS The pandemic has shed light on clinicians' commitment to professionalism and service as we rapidly adapt to changing paradigms. Interventions that appeal to professional norms can help improve the efficacy of new systems of practice. We show that specialists' performance can be measured and improved with feedback using aspirational norms. TRIAL REGISTRATION clinicaltrials.gov NCT03784950.
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Affiliation(s)
- Daniella Meeker
- Department of Population and Public Health Sciences, University of Southern California, 2250 Alcazar St, Los Angeles, CA, 90033, USA.
| | - Mark W Friedberg
- Brigham and Women's Hospital, Boston, MA, USA
- Blue Cross Blue Shield of Massachusetts, Boston, MA, USA
| | - Tara K Knight
- Sol Price School of Public Policy & Leonard D. Schaeffer Center for Health Policy & Economics, University of Southern California, Los Angeles, CA, USA
| | - Jason N Doctor
- Sol Price School of Public Policy & Leonard D. Schaeffer Center for Health Policy & Economics, University of Southern California, Los Angeles, CA, USA
| | - Dina Zein
- Department of Population and Public Health Sciences, University of Southern California, 2250 Alcazar St, Los Angeles, CA, 90033, USA
| | | | - Noah J Goldstein
- Anderson School of Management, University of California, Los Angeles, Los Angeles, USA
| | - Craig R Fox
- Anderson School of Management, University of California, Los Angeles, Los Angeles, USA
| | - Jeffrey A Linder
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Stephen D Persell
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Stanley Dea
- Los Angeles County Department of Health Services, Los Angeles, CA, USA
| | - Paul Giboney
- Los Angeles County Department of Health Services, Los Angeles, CA, USA
| | - Hal F Yee
- Los Angeles County Department of Health Services, Los Angeles, CA, USA
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3
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Daneman N, Lee SM, Bai H, Bell CM, Bronskill SE, Campitelli MA, Dobell G, Fu L, Garber G, Ivers N, Lam JMC, Langford BJ, Laur C, Morris A, Mulhall C, Pinto R, Saxena FE, Schwartz KL, Brown KA. Population-Wide Peer Comparison Audit and Feedback to Reduce Antibiotic Initiation and Duration in Long-Term Care Facilities with Embedded Randomized Controlled Trial. Clin Infect Dis 2021; 73:e1296-e1304. [PMID: 33754632 DOI: 10.1093/cid/ciab256] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 03/19/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Antibiotic overprescribing in long-term care settings is driven by prescriber preferences and is associated with preventable harms for residents. We aimed to determine whether peer comparison audit and feedback reporting for physicians reduces antibiotic overprescribing among residents. METHODS We employed a province wide, difference-in-differences study of antibiotic prescribing audit and feedback, with an embedded pragmatic randomized controlled trial (RCT) across all long-term care facilities in Ontario, Canada, in 2019. The study year included 1238 physicians caring for 96 185 residents. In total, 895 (72%) physicians received no feedback; 343 (28%) were enrolled to receive audit and feedback and randomized 1:1 to static or dynamic reports. The primary outcomes were proportion of residents initiated on an antibiotic and proportion of antibiotics prolonged beyond 7 days per quarter. RESULTS Among all residents, between the first quarter of 2018 and last quarter of 2019, there were temporal declines in antibiotic initiation (28.4% to 21.3%) and prolonged duration (34.4% to 29.0%). Difference-in-differences analysis confirmed that feedback was associated with a greater decline in prolonged antibiotics (adjusted difference -2.65%, 95% confidence interval [CI]: -4.93 to -.28%, P = .026), but there was no significant difference in antibiotic initiation. The reduction in antibiotic durations was associated with 335 912 fewer days of treatment. The embedded RCT detected no differences in outcomes between the dynamic and static reports. CONCLUSIONS Peer comparison audit and feedback is a pragmatic intervention that can generate small relative reductions in the use of antibiotics for prolonged durations that translate to large reductions in antibiotic days of treatment across populations. Clinical Trials Registration. NCT03807466.
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Affiliation(s)
- Nick Daneman
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Public Health Ontario, Toronto, Ontario, Canada.,Institute for Clinical Evaluative Sciences (ICES), Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Samantha M Lee
- Institute for Clinical Evaluative Sciences (ICES), Toronto, Ontario, Canada
| | - Heming Bai
- Ontario Health, Toronto, Ontario, Canada
| | - Chaim M Bell
- Institute for Clinical Evaluative Sciences (ICES), Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Susan E Bronskill
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Institute for Clinical Evaluative Sciences (ICES), Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Women's College Hospital Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, Ontario, Canada
| | | | | | - Longdi Fu
- Institute for Clinical Evaluative Sciences (ICES), Toronto, Ontario, Canada
| | - Gary Garber
- Public Health Ontario, Toronto, Ontario, Canada.,Department of Medicine, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Noah Ivers
- Institute for Clinical Evaluative Sciences (ICES), Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Women's College Hospital Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, Ontario, Canada
| | | | | | - Celia Laur
- Women's College Hospital Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, Ontario, Canada
| | - Andrew Morris
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada
| | | | - Ruxandra Pinto
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Farah E Saxena
- Institute for Clinical Evaluative Sciences (ICES), Toronto, Ontario, Canada
| | - Kevin L Schwartz
- Public Health Ontario, Toronto, Ontario, Canada.,Institute for Clinical Evaluative Sciences (ICES), Toronto, Ontario, Canada
| | - Kevin A Brown
- Public Health Ontario, Toronto, Ontario, Canada.,Institute for Clinical Evaluative Sciences (ICES), Toronto, Ontario, Canada
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4
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Buehrle DJ, Shively NR, Wagener MM, Clancy CJ, Decker BK. Sustained Reductions in Overall and Unnecessary Antibiotic Prescribing at Primary Care Clinics in a Veterans Affairs Healthcare System Following a Multifaceted Stewardship Intervention. Clin Infect Dis 2021; 71:e316-e322. [PMID: 31813965 DOI: 10.1093/cid/ciz1180] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 12/06/2019] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Most antibiotic prescribing is in outpatient settings. However, antibiotic stewardship has focused overwhelmingly on hospitalized patients. In a few studies, behavioral interventions decreased unnecessary outpatient prescribing against acute respiratory infections, but data are conflicting on sustained benefits after intervention discontinuation. METHODS We conducted a prospective, observational study in 7 primary care clinics, in which an intervention comprised of clinician education, peer comparisons, and computer decision support order sets was directed against all antibiotic prescribing. After 6 months, peer comparisons were discontinued. Antibiotic prescribing was compared in the baseline (January-June 2016), intervention (January-June 2017), and postintervention (January-June 2018) periods. RESULTS Mean antibiotic prescriptions significantly decreased from 76.9 (baseline) to 49.5 (intervention) and 56.3 (postintervention) per 1000 visits (35.6% and 26.8% reductions, respectively; P values < .001). The rate of unnecessary antibiotic prescribing (ie, antibiotic not indicated) decreased from 58.8% (baseline) to 37.8% (intervention) and 44.3% (postintervention) (35.7% and 24.7% decreases, respectively; P = .001 and P = .01). Overall, 19.9% (27/136), 36.6% (66/180), and 34.9% (67/192) of antibiotics were prescribed optimally (ie, antibiotics were indicated, and a guideline-concordant agent was prescribed for guideline-concordant duration) during the baseline, intervention, and postintervention periods, respectively (baseline vs intervention and postintervention, P = .001 and P = .003, respectively). Differences between intervention and postintervention periods in overall, unnecessary, or optimal antibiotic prescribing were not significant. CONCLUSIONS A multifaceted outpatient stewardship intervention achieved reductions in overall, unnecessary, and suboptimal antibiotic prescription rates, which were sustained for a year after components of the intervention were discontinued. There is opportunity for further improvement, as inappropriate and suboptimal prescribing remained common.
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Affiliation(s)
- Deanna J Buehrle
- Infectious Diseases Section, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
| | - Nathan R Shively
- Division of Infectious Diseases, Allegheny Health Network, Pittsburgh, Pennsylvania, USA
| | - Marilyn M Wagener
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Cornelius J Clancy
- Infectious Diseases Section, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA.,Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Brooke K Decker
- Infectious Diseases Section, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
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5
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Buehrle DJ, Phulpoto RH, Wagener MM, Clancy CJ, Decker BK. Decreased Overall and Inappropriate Antibiotic Prescribing in a Veterans Affairs Hospital Emergency Department following a Peer Comparison-Based Stewardship Intervention. Antimicrob Agents Chemother 2020; 65:e01660-20. [PMID: 33020159 DOI: 10.1128/AAC.01660-20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 10/01/2020] [Indexed: 12/19/2022] Open
Abstract
Antibiotic prescribing is very common in emergency departments (EDs). Optimal stewardship intervention strategies in EDs are not well defined. We conducted a prospective, observational cohort study in a Veterans Affairs ED in which clinician education and monthly e-mail-based peer comparisons were directed against all oral antibiotic prescribing for discharged patients. Oral antibiotic prescriptions were compared in baseline (June 2016 to December 2017) and intervention (January to June 2018) periods using an interrupted time series regression model. Prescribing appropriateness was compared during January to June 2017 and the intervention period. During the intervention period, antibiotic prescriptions decreased monthly by 10.4 prescriptions per 1,000 ED visits (P = 0.07 [95% confidence interval {CI}, -21.7 to 1.0]). The relative decrease in the trend of antibiotic prescriptions during the intervention period compared to baseline was 9.9 prescriptions per 1,000 ED visits per month (P = 0.07 [95% CI, -20.9 to 1.0]). The intervention was associated with a significant decrease and increase in amoxicillin-clavulanate and cephalexin prescriptions, respectively (P < 0.001, P = 0.004). Decreasing trends in ciprofloxacin prescriptions during the baseline period were maintained during the intervention. Unnecessary antibiotic prescribing (i.e., antibiotic not indicated) decreased from 55.6% to 38.7% during the intervention (30.4% decrease, P = 0.003). Optimal antibiotic prescribing (i.e., antibiotics were indicated, and a guideline-concordant agent was prescribed for guideline-concordant duration) increased by 36% (21.6% to 29.3%, P = 0.12). A peer comparison-based stewardship intervention directed at ED clinicians was associated with reductions in overall and unnecessary oral antibiotic prescribing. There is potential to further improve antibiotic use as suboptimal prescribing remained common.
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6
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Shively NR, Buehrle DJ, Wagener MM, Clancy CJ, Decker BK. Improved Antibiotic Prescribing within a Veterans Affairs Primary Care System through a Multifaceted Intervention Centered on Peer Comparison of Overall Antibiotic Prescribing Rates. Antimicrob Agents Chemother 2019; 64:e00928-19. [PMID: 31685466 PMCID: PMC7187573 DOI: 10.1128/aac.00928-19] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 10/27/2019] [Indexed: 02/05/2023] Open
Abstract
Reducing inappropriate outpatient antibiotic use is an important national goal. Limited data exist on targeted education and peer comparison of overall antibiotic prescribing rates as an antimicrobial stewardship strategy. Primary care professionals (PCPs) from all seven clinics within our health care system were offered an education session, followed by monthly e-mails with their antibiotic prescribing rate, peer prescribing rates, and a system target. A pre-post analysis was conducted to compare prescribing rates during the intervention period (January to June 2017) to a seasonal baseline (January to June 2016) using a regression model. A random sample of prescriptions was reviewed for adherence to consensus guidelines. Educational sessions were attended by 68.5% (50/73) of PCPs. From the baseline to the intervention period, the mean rate of monthly antibiotic prescriptions declined from 76.9 to 49.5 per 1,000 office visits (35.6% reduction [P < 0.001]). Among reviewed cases, unnecessary antibiotic prescribing declined (58.8% [80/136] versus 38.9% [70/180]; 33.9% reduction [P = 0.0006]), and the rate of optimally prescribed antibiotics increased (19.9% [27/136] versus 30% [54/180]; 50.8% increase [P = 0.05]). If an antibiotic was indicated, there were no significant differences in prescribing of guideline-discordant agents (21.4% [12/56] versus 19.1% [21/110] [P = 0.8]) or guideline-concordant agents for a guideline-discordant duration (38.6% [17/44] versus 39.3% [35/89] [P = 1]). There were significant reductions in azithromycin and fluoroquinolone prescriptions (50.9% and 59.4% [P values of <0.001], respectively), but most prescriptions for these agents in the intervention period remained inappropriate. Initial education followed by monthly peer comparison of overall antibiotic prescribing rates reduced total and unnecessary antibiotic prescribing in primary care clinics.
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Affiliation(s)
- Nathan R Shively
- Division of Infectious Diseases, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Deanna J Buehrle
- Infectious Diseases Section, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
| | - Marilyn M Wagener
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Cornelius J Clancy
- Division of Infectious Diseases, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
- Infectious Diseases Section, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
| | - Brooke K Decker
- Division of Infectious Diseases, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
- Infectious Diseases Section, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
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7
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Trent SA, Havranek EP, Ginde AA, Haukoos JS. Effect of Audit and Feedback on Physician Adherence to Clinical Practice Guidelines for Pneumonia and Sepsis. Am J Med Qual 2018; 34:217-225. [PMID: 30205697 DOI: 10.1177/1062860618796947] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
The objective was to estimate the effect of feedback with blinded peer comparison on emergency physician adherence to guidelines for appropriate antibiotic administration for inpatient pneumonia and completion of the 3-hour Surviving Sepsis Bundle for severe sepsis. The authors performed a quasi-experiment using a stepped wedge design at a single urban safety net hospital. Attending emergency physicians were randomized into 6 clusters. Once a cluster crossed into the intervention group, physicians in that cluster began receiving detailed feedback with blinded peer comparison on their adherence to guidelines for pneumonia and sepsis. Feedback with blinded peer comparison significantly improved guideline adherence from 52% without feedback to 65% with feedback (difference = 13%, 95% confidence interval = 4% to 22%). In adjusted analyses, the odds of providing guideline adherent care were 1.8 (95% confidence interval = 1.01-3.2) after the introduction of feedback with blinded peer comparison. Feedback with blinded peer comparison significantly improved emergency physician guideline adherence.
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Affiliation(s)
- Stacy A Trent
- 1 Denver Health Medical Center, Denver, CO.,2 University of Colorado, Aurora, CO
| | - Edward P Havranek
- 1 Denver Health Medical Center, Denver, CO.,2 University of Colorado, Aurora, CO
| | - Adit A Ginde
- 2 University of Colorado, Aurora, CO.,3 Colorado School of Public Health, Aurora, CO
| | - Jason S Haukoos
- 1 Denver Health Medical Center, Denver, CO.,2 University of Colorado, Aurora, CO.,3 Colorado School of Public Health, Aurora, CO
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8
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McIntyre MT, Naik L, Bell CM, Morris AM. Development and Assessment of a Physician-Specific Antimicrobial Usage and Spectrum Feedback Tool. Open Forum Infect Dis 2017; 4:ofx124. [PMID: 30591917 PMCID: PMC6300305 DOI: 10.1093/ofid/ofx124] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 06/14/2017] [Indexed: 11/13/2022] Open
Abstract
Individualized data are required but difficult to obtain for effective antimicrobial stewardship audit and feedback. We developed a summative tool to evaluate consumption (days of therapy per 100 patient-days) and spectrum of antimicrobials that was also acceptable to individual clinicians.
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Affiliation(s)
- Mark T McIntyre
- Sinai Health System/University Health Network Antimicrobial Stewardship Program.,Leslie Dan Faculty of Pharmacy, University of Toronto.,University Health Network
| | - Lopa Naik
- Sinai Health System/University Health Network Antimicrobial Stewardship Program.,University Health Network
| | - Chaim M Bell
- Sinai Health System/University Health Network Antimicrobial Stewardship Program.,University Health Network.,Sinai Health System.,Department of Medicine, University of Toronto.,Institute for Clinical Evaluative Sciences, Toronto, Ontario
| | - Andrew M Morris
- Sinai Health System/University Health Network Antimicrobial Stewardship Program.,University Health Network.,Sinai Health System.,Department of Medicine, University of Toronto.,Division of Infectious Diseases, University of Toronto
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9
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Spring H, Datta S, Sapkota S. Using Behavioral Science to Design a Peer Comparison Intervention for Postabortion Family Planning in Nepal. Front Public Health 2016; 4:123. [PMID: 27446891 PMCID: PMC4914549 DOI: 10.3389/fpubh.2016.00123] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 06/01/2016] [Indexed: 11/30/2022] Open
Abstract
Despite the provision of free and subsidized family planning services and clients' demonstrated intentions to delay pregnancies, family planning uptake among women who receive abortion and postabortion services at Sunaulo Parivar Nepal (SPN), one of Nepal's largest non-governmental sexual and reproductive health (SRH) providers, remains low. Through meetings, interviews, and observations with SPN's stakeholders, service providers, and clients at its 36 SRH centers, we developed hypotheses about client- and provider-side barriers that may inhibit postabortion family planning (PAFP) uptake. On the provider side, we found that the lack of benchmarks (such as the performance of other facilities) against which providers could compare their own performance and the lack of feedback on the performance were important barriers to PAFP uptake. We designed several variants of three interventions to address these barriers. Through conversations with team members at SPN's centralized support office and service providers at SPN centers, we prioritized a peer-comparison tool that allows providers at one center to compare their performance with that of other similar centers. We used feedback from the community of providers on the tools' usability and features to select a variant of the tool that also leverages and reinforces providers' strong intrinsic motivation to provide quality PAFP services. In this paper, we detail the process of identifying barriers and creating an intervention to overcome those barriers. The intervention's effectiveness will be tested with a center-level, stepped-wedge randomized control trial in which SPN's 36 centers will be randomly assigned to receive the intervention at 1-month intervals over a 6-month period. Existing medical record data will be used to monitor family planning uptake.
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