Suspected urinary tract infection (UTI) is the most common type of infection occurring in nursing home residents, and the most common reason for use of antibiotics in the LTC setting. Unfortunately, the majority of antibiotics used for suspecte UTI are inappropriately prescribed. Many suspected nursing home UTI are actually cases of asymptomatic bacteriuria, treatment of which does not improve patient outcomes and may cause harm. In addition to unnecessary drug use, inappropriate treatment may also occur as a result of incorrect antibiotic choice, dose, or duration. While there have been numerous randomized trials to improve suboptimal prescribing in nursing homes, only two specifically targeted treatment of UTI. These studies demonstrated only a modest impact on antibiotic usage and did not target appropriateness of treatment. Consequently, there is a critical need for studies attempting to disseminate effective strategies for the optimal evaluation and treatment of UTI in nursing homes. Our long-term goal is to enhance the health of older nursing home residents with suspected UTI by increasing the appropriateness of antibiotic use through the dissemination of a multifaceted intervention. We will achieve the objectives of this project through two specific aims: 1) evaluate whether the intervention improves antimicrobial prescribing for suspected UTI, and 2) develop and disseminate, in partnership with AMDA, a tool kit based on the protocol used by the intervention group to improve suspected UTI management in control and other nursing homes. In the first aim, we will conduct a cluster randomized controlled trial involving 40 nursing homes in four U.S. geographic regions. Using the Institute of Medicine Patient Safety Model as a guide, we will design and implement a toolkit of communication tools, checklists, and decision support tools targeting various health care providers and nursing home residents/families. Continuous quality improvement methodology, including audit, feedback, and dashboard monitoring, will be applied. The project team will assess the quality and safety of antibiotic prescribing for each suspected UTI and the adverse events monitored. In the second aim, we will revise and disseminate the tool kit, first to control homes, and subsequently, to homes nationally through web and print components as well as media outreach. The methods used to implement and disseminate this project, and the rigorous evaluation of pertinent outcomes, are all innovative aspects of this proposal. The proposed research is significant because it is expected to result in an effective multifaceted intervention that can be exported broadly to improve appropriateness of antibiotic use for UTI, the leading infection in nursing homes. This will, in turn, lessen the risk of adverse drug events, help reduce the growing threat of antimicrobial resistance, and diminish the risk of Clostridium difficile infection.

Public Health Relevance

Suboptimal use of antibiotics for suspected urinary tract infections (UTI) in older nursing home patients can lead to reduced kidney function; the use of multiple medications to treat the UTI; and, ultimately, an injury resulting from use of medication; resistance to antibiotics; and clostridium difficile infections that are difficult to treat and whih can be life-threatening. The infections caused by antibiotic-resistant organisms are associated with increases in hospital transfers, length of hospital stays, deaths, and costs. The proposed project will update the clinical practice guidelines for evaluating and treating suspected UTI; train nursing home staff to address this high-risk, high-priority condition and implement appropriate improvement; and, ultimately, enhance the health of older nursing home residents with suspected UTI by broadly disseminating this multifaceted intervention to other nursing homes throughout the U.S. i

Agency
National Institute of Health (NIH)
Institute
Agency for Healthcare Research and Quality (AHRQ)
Type
Research Demonstration and Dissemination Projects (R18)
Project #
5R18HS023779-02
Application #
9078027
Study Section
Healthcare Patient Safety and Quality Improvement Research (HSQR)
Program Officer
Perfetto, Deborah
Project Start
2015-06-03
Project End
2018-05-31
Budget Start
2016-07-15
Budget End
2017-05-31
Support Year
2
Fiscal Year
2016
Total Cost
Indirect Cost
Name
University of Pittsburgh
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
004514360
City
Pittsburgh
State
PA
Country
United States
Zip Code
15213
Gray, Shelly L; Hart, Laura A; Perera, Subashan et al. (2018) Meta-analysis of Interventions to Reduce Adverse Drug Reactions in Older Adults. J Am Geriatr Soc 66:282-288
Koronkowski, Michael J; Semla, Todd P; Schmader, Kenneth E et al. (2017) Recent Literature Update on Medication Risk in Older Adults, 2015-2016. J Am Geriatr Soc 65:1401-1405
Hanlon, J T; Perera, S; Newman, A B et al. (2017) Potential drug-drug and drug-disease interactions in well-functioning community-dwelling older adults. J Clin Pharm Ther 42:228-233
Niznik, Joshua; Zhao, Xinhua; Jiang, Tao et al. (2017) Anticholinergic Prescribing in Medicare Part D Beneficiaries Residing in Nursing Homes: Results from a Retrospective Cross-Sectional Analysis of Medicare Data. Drugs Aging 34:925-939
Nace, David A; Archbald-Pannone, Laurie R; Ashraf, Muhammad S et al. (2017) Pneumococcal Vaccination Guidance for Post-Acute and Long-Term Care Settings: Recommendations From AMDA's Infection Advisory Committee. J Am Med Dir Assoc 18:99-104
Hanlon, Joseph T; Zhao, Xinhua; Naples, Jennifer G et al. (2017) Central Nervous System Medication Burden and Serious Falls in Older Nursing Home Residents. J Am Geriatr Soc 65:1183-1189
Jump, Robin L P; Gaur, Swati; Katz, Morgan J et al. (2017) Template for an Antibiotic Stewardship Policy for Post-Acute and Long-Term Care Settings. J Am Med Dir Assoc 18:913-920
Marcum, Zachary A; Hanlon, Joseph T; Murray, Michael D (2017) Improving Medication Adherence and Health Outcomes in Older Adults: An Evidence-Based Review of Randomized Controlled Trials. Drugs Aging 34:191-201
Tilson, Hugh; Hines, Lisa E; McEvoy, Gerald et al. (2016) Recommendations for selecting drug-drug interactions for clinical decision support. Am J Health Syst Pharm 73:576-85
Driessen, Julia; Bonhomme, Andro; Chang, Woody et al. (2016) Nursing Home Provider Perceptions of Telemedicine for Reducing Potentially Avoidable Hospitalizations. J Am Med Dir Assoc 17:519-24

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