Dr. Deshpande is a junior faculty member at the Medicine Institute Center for Value-Based Care Research, Assistant Staff in the Departments of Internal Medicine and Infectious Diseases at Cleveland Clinic, and an Assistant Professor of Medicine at the Cleveland Clinic Lerner College of Medicine at Case Western Reserve University, Cleveland, OH. The goal of this career development award is to provide training in health services research, including mentored application of rigorous research methods to identify effective diagnostic and treatment strategies for patients with CAP. Through his current project, he will add to our understanding of antimicrobial therapy for CAP. Future projects will apply these findings to design interventions that help clinicians make better antibiotic choices. His long term goal is to become a leading clinical researcher performing health services research in infectious diseases. Despite being one of the leading causes of hospitalization in the US, there remain many unanswered questions regarding the optimal diagnosis and treatment of CAP. CAP continues to be a leading cause of hospitalization and death in the United States. Growing antimicrobial resistance nationally further complicates the selection of an appropriate initial therapeutic regimen. Physicians must ensure that patients with CAP caused by resistant organisms receive appropriate treatment, while minimizing overuse of broad-spectrum antibiotics. Given its enormous impact and the increasing prevalence of antibiotic resistance there is a critical need for research efforts focused on identifying the changing microbial etiology and the best practices for CAP antimicrobial therapy. In this career development award, Dr. Deshpande proposes to study 3 questions and in so doing will acquire new research methods and experience working with 3 distinct large datasets. The questions are as follows: 1) What are the current epidemiology and antibiotic resistance patterns of CAP in the US? 2) What is the relationship between local antibiotic resistance patterns, physician prescribing and patient outcomes? And 3) Does early switch therapy from intravenous to oral antibiotics reduce length of stay (LOS) and cost without increasing treatment failure or readmissions. The proposed career development plan incorporates advanced training in infectious disease epidemiology, comparative effectiveness and large database cohort studies, as well as closely mentored research. His very strong mentorship team is led by Dr. Rothberg, who is an established outcomes researcher with an interest in healthcare associated pneumonia and supported through federal funding. The proposed series of investigations, using a rich dataset derived from 3 large databases, will generate important new knowledge about CAP management practices and associated patient outcomes. The research speaks directly to President Obama?s recent initiative: ?National Strategy for Combating Antibiotic-Resistant Bacteria?.

Public Health Relevance

Community-acquired pneumonia (CAP) is a leading cause of hospitalizations and death in the United States. Despite its significant impact, little is known about the about the variation in microbial etiology by hospital or their antibiotic resistance patterns; identification of the causative organism?s antibiotic susceptibility is key to appropriate antibiotic prescribing. This proposal will use rigorous research methods in three large observational databases for the identification and implementation of effective treatment strategies for patients with CAP.

Agency
National Institute of Health (NIH)
Institute
Agency for Healthcare Research and Quality (AHRQ)
Type
Clinical Investigator Award (CIA) (K08)
Project #
1K08HS025026-01
Application #
9224112
Study Section
HSR Health Care Research Training SS (HCRT)
Program Officer
Willis, Tamara
Project Start
2016-09-15
Project End
2021-08-31
Budget Start
2016-09-15
Budget End
2017-08-31
Support Year
1
Fiscal Year
2016
Total Cost
Indirect Cost
Name
Cleveland Clinic Lerner
Department
Type
DUNS #
City
Cleveland
State
OH
Country
United States
Zip Code
44195
Le, Phuc; Nghiem, Van T; Mullen, Patricia Dolan et al. (2018) Cost-Effectiveness of Competing Treatment Strategies for Clostridium difficile Infection: A Systematic Review. Infect Control Hosp Epidemiol 39:412-424