scholarly journals Description of antibiotic use variability among US nursing homes using electronic health record data

2021 ◽  
Vol 1 (1) ◽  
Author(s):  
Sarah Kabbani ◽  
Stanley W. Wang ◽  
Laura L. Ditz ◽  
Katryna A. Gouin ◽  
Danielle Palms ◽  
...  
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Electronic Health Record ◽  
Antibiotic Use ◽  
Health Record ◽  
Short Stay ◽  
Prescribing Practices ◽  
Electronic Health ◽  
Facility Level ◽  
Tract Infections

Abstract Background: Antibiotics are frequently prescribed in nursing homes; national data describing facility-level antibiotic use are lacking. The objective of this analysis was to describe variability in antibiotic use in nursing homes across the United States using electronic health record orders. Methods: A retrospective cohort study of antibiotic orders for 309,884 residents in 1,664 US nursing homes in 2016 were included in the analysis. Antibiotic use rates were calculated as antibiotic days of therapy (DOT) per 1,000 resident days and were compared by type of stay (short stay ≤100 days vs long stay >100 days). Prescribing indications and the duration of nursing home-initiated antibiotic orders were described. Facility-level correlations of antibiotic use, adjusting for resident health and facility characteristics, were assessed using multivariate linear regression models. Results: In 2016, 54% of residents received at least 1 systemic antibiotic. The overall rate of antibiotic use was 88 DOT per 1,000 resident days. The 3 most common antibiotic classes prescribed were fluoroquinolones (18%), cephalosporins (18%), and urinary anti-infectives (9%). Antibiotics were most frequently prescribed for urinary tract infections, and the median duration of an antibiotic course was 7 days (interquartile range, 5–10). Higher facility antibiotic use rates correlated positively with higher proportions of short-stay residents, for-profit ownership, residents with low cognitive performance, and having at least 1 resident on a ventilator. Available facility-level characteristics only predicted a small proportion of variability observed (Model R2 version 0.24 software). Conclusions: Using electronic health record orders, variability was found among US nursing-home antibiotic prescribing practices, highlighting potential opportunities for targeted improvement of prescribing practices.

scholarly journals Experiences with the Liverpool care pathway for the dying patient in nursing home residents: a mixed-method study to assess physicians’ and nurse practitioners’ perceptions

2020 ◽  
Vol 19 (1) ◽  
Author(s):  
Maartje S. Klapwijk ◽  
Natashe Lemos Dekker ◽  
Monique A. A. Caljouw ◽  
Wilco P. Achterberg ◽  
Jenny T. van der Steen
Keyword(s):  
Palliative Care ◽  
Nursing Home ◽  
Nursing Homes ◽  
Electronic Health Record ◽  
Nurse Practitioners ◽  
Care Pathway ◽  
Nursing Home Residents ◽  
Health Record ◽  
Electronic Health ◽  
Dying Patient

Abstract Background The Liverpool care pathway for the dying patient (LCP) is a multidisciplinary tool developed for the dying phase for use in palliative care settings. The literature reports divergent experiences with its application in a nursing home setting related to its implementation and staff competencies. The aim of this study is to understand how the LCP is being used in the context of the nursing home, including for residents with dementia, and experienced from the perspectives of those responsible for medical treatment in nursing homes. Methods A mixed-methods approach was used, consisting of a survey followed by interviews. A link to a 9-item online survey with closed and open-ended questions was emailed to all physicians and nurse practitioners of 33 care organisations with nursing homes in three regions of the Netherlands (North, West and South). In addition, 10 respondents with particularly positive or negative experiences were selected for semi-structured interviews. Results The survey was completed by 159 physicians and nurse practitioners. The respondents were very positive on the content and less positive on the use of the LCP, although they reported difficulties identifying the right time to start the LCP, especially in case of dementia. Also using the LCP was more complicated after the implementation of the electronic health record. The LCP was judged to be a marker of quality for the assessment of symptoms in the dying phase and communication with relatives. Conclusion An instrument that prompts regular assessment of a dying person was perceived by those responsible for (medical) care to contribute to good care. As such, the LCP was valued, but there was a clear need to start it earlier than in the last days or hours of life, a need for a shorter version, and for integration of the LCP in the electronic health record. Regular assessments with an instrument that focusses on quality of care and good symptom control can improve palliative care for nursing home residents with and without dementia.

scholarly journals 970. Antibiotic Use Variability Among US Nursing Homes—2016

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S33-S33
Author(s):  
Sarah Kabbani ◽  
Stanley Wang ◽  
Laura Ditz ◽  
Danielle Palms ◽  
Theresa Rowe ◽  
...  
Keyword(s):  
Nursing Homes ◽  
Antibiotic Use ◽  
Prescribing Practices ◽  
For Profit ◽  
Case Mix Index ◽  
Not For Profit ◽  
Median Proportion ◽  
Days Of Therapy ◽  
Facility Level ◽  
Tract Infections

Abstract Background Antibiotics are frequently prescribed in nursing homes (NH). National data describing facility-level antibiotic use (AU) in NH are lacking. The objectives of this analysis were to use NH electronic health records (EHR) to describe AU in NH and variability in AU rates across NH. Methods We analyzed antibiotic orders for 309,884 residents in 1,664 US NHs using one EHR company in 2016. We calculated AU rates as antibiotic days-of-therapy (DOT) per 1,000 resident-days and compared by the type of stay (short-stay (SS) ≤ 100 days vs. long-stay (LS) >100 days). We also examined prescribing indications and the duration of nursing home-initiated antibiotic orders. We assessed facility-level correlates of AU using resident health and NH facility characteristics publically available through NH Compare and LTCfocus using a univariate linear regression. Results In 2016, 57% of NH residents received at least one systemic antibiotic; overall rate of AU was 90 DOT/1,000 resident-days. The median facility-level AU rate was 64 DOT/1,000 resident-days (IQR 36–104). The median proportion of SS residents at a facility was 74% (IQR 60–84%). The SS and LS AU rates were 241 DOT/1,000 resident-days (IQR 173–342) and 24 DOT/1,000 resident-days (IQR 14–37), respectively. Overall, the three most common antibiotic classes prescribed were fluoroquinolones (18%), cephalosporins (18%), and extended-spectrum β-lactams (10%). Antibiotics were most frequently prescribed for urinary tract infections, and the mean duration of an antibiotic order was 9 days (range 1–365). Higher facility AU rate correlated positively with the following facility characteristics; proportion of SS residents, urban location, proportion of residents with mild cognitive impairment and lower activities of daily living scores, presence of ventilator beds, proportion of LS residents with urinary catheters or pressure ulcers, facility case-mix index, and not-for-profit ownership and multiorganization facilities. Conclusion Significant variability in NH AU rates exist, and SS residents have higher AU rates. Identifying NH with high rates of AU after adjusting for facility-level predictors of AU may identify opportunities for targeting efforts to improve prescribing practices. Disclosures All Authors: No reported Disclosures.

scholarly journals Advice for Decision Makers Based on an Electronic Health Record Evaluation at a Program for All-inclusive Care for Elders Site

2011 ◽  
Vol 02 (01) ◽  
pp. 18-38 ◽  
Author(s):  
J.P. Weiner ◽  
K.H. Bowles ◽  
P. Abbott ◽  
H.P. Lehmann ◽  
P.S. Sockolow
Keyword(s):  
Nursing Home ◽  
Mixed Methods ◽  
Electronic Health Record ◽  
Functional Outcome ◽  
Decision Makers ◽  
Evidence Based ◽  
Health Record ◽  
Clinician Satisfaction ◽  
Electronic Health ◽  
The Impact

Summary Objective: Provide evidence-based advise to “Program of All-inclusive Care for the Elderly” (PACE) decision makers considering implementing an electronic health record (EHR) system, drawing on the results of a mixed methods study to examine: (1) the diffusion of an EHR among clinicians documenting direct patient care in a PACE day care site, (2) the impact of the use of the EHR on the satisfaction levels of clinicians, and (3) the impact of the use of the EHR on patient functional outcomes. Methods: Embedded mixed methods design with a post-test design quantitative experiment and concurrent qualitative component. Quantitative methods included: (1) the EHR audit log used to determine the frequency and timing during the week of clinicians’ usage of the system; (2) a 22-item clinician satisfaction survey; and (3) a 16-item patient functional outcome questionnaire related to locomotion, mobility, personal hygiene, dressing, feeding as well the use of adaptive devices. Qualitative methods included observations and open-ended, semi-structured follow-up interviews. Qualitative data was merged with the quantitative data by comparing the findings along themes. The setting was a PACE utilizing an EHR in Philadelphia: PACE manages the care of nursing-home eligible members to enable them to avoid nursing home admission and reside in their homes. Participants were 39 clinicians on the multi-disciplinary teams caring for the elders and 338 PACE members. Results: Clinicians did not use the system as intended, which may help to explain why the benefits related to clinical processes and patient outcomes as expected for an EHR were not reflected in the results. Clinicians were satisfied with the EHR, although there was a non-significant decline between 11 and 17 months post implementation of the EHR. There was no significant difference in patient functional outcome the two time periods. However, the sample size of 48 was too small to allow any conclusive statements to be made. Interpretation of findings underscores the importance of the interaction of workflow and EHR functionality and usability to impact clinician satisfaction, efficiency, and clinician use of the EHR. Conclusion: This research provides insights into EHR use in the care of the older people in community-based health care settings. This study assessed the adoption of an EHR outside the acute hospital setting and in the community setting to provide evidence-based recommendations to PACE decision makers considering implementing an EHR.

scholarly journals Identification of urinary tract infections using electronic health record data

2019 ◽  
Vol 47 (4) ◽  
pp. 371-375
Author(s):  
Kathryn L. Colborn ◽  
Michael Bronsert ◽  
Karl Hammermeister ◽  
William G. Henderson ◽  
Abhinav B. Singh ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Electronic Health Record ◽  
Urinary Tract Infections ◽  
Health Record ◽  
Electronic Health Record Data ◽  
Record Data ◽  
Electronic Health ◽  
Tract Infections

scholarly journals Comparison of antibiotic prescribing records in two UK primary care electronic health record systems: cohort study using CPRD GOLD and CPRD Aurum databases

BMJ Open ◽  
2020 ◽  
Vol 10 (6) ◽  
pp. e038767
Author(s):  
Martin C Gulliford ◽  
Xiaohui Sun ◽  
Thamina Anjuman ◽  
Eleanor Yelland ◽  
Tarita Murray-Thomas
Keyword(s):  
Primary Care ◽  
Cohort Study ◽  
Electronic Health Record ◽  
Clinical Practice Research Datalink ◽  
Antibiotic Prescribing ◽  
Health Record ◽  
Medical Diagnoses ◽  
General Practices ◽  
Electronic Health ◽  
Tract Infections

ObjectivesWe aimed to evaluate recording of antibiotic prescribing from two primary care electronic health record systems.DesignCohort study.SettingUK general practices contributing to the Clinical Practice Research Datalink (CPRD) databases: CPRD GOLD (Vision data) and CPRD Aurum (EMIS data). English CPRD GOLD general practices were analysed as a subgroup, as all CPRD Aurum practices were located in England.Participants158 305 patients were randomly sampled from CPRD Aurum and 160 394 from CPRD GOLD.Outcome measuresAntibiotic prescriptions in 2017 were identified. Age-standardised and sex-standardised antibiotic prescribing rates per 1000 person years were calculated. Prescribing of individual antibiotic products and associated medical diagnoses was evaluated.ResultsThere were 101 360 antibiotic prescriptions at 883 CPRD Aurum practices and 112 931 prescriptions at 290 CPRD GOLD practices, including 112 general practices in England. The age-standardised and sex-standardised antibiotic prescribing rate in 2017 was 512.6 (95% CI 510.4 to 514.9) per 1000 person years in CPRD Aurum and 584.3 (582.1 to 586.5) per 1000 person years in CPRD GOLD (505.2 (501.6 to 508.9) per 1000 person years if restricted to practices in England). The 25 most frequently prescribed antibiotic products were similar in both databases. One or more medical codes were recorded on the same date as an antibiotic prescription for 72 989 (74%) prescriptions in CPRD Aurum, 84 756 (78%) in CPRD GOLD and 28 471 (78%) for CPRD GOLD in England. Skin, respiratory and genitourinary tract infections were recorded for 39 035 (40%) prescriptions in CPRD Aurum, 41 326 (38%) in CPRD GOLD, with 15 481 (42%) in English CPRD GOLD practices only.ConclusionEstimates for antibiotic prescribing and infection recording were broadly similar in both databases suggesting similar recording across EMIS and Vision systems. Future research on antimicrobial stewardship can also be conducted using primary care data in CPRD Aurum.

scholarly journals Appropriateness of Initiating Antibiotics for Urinary Tract Infection Among Nursing Home Residents

2020 ◽  
Vol 41 (S1) ◽  
pp. s127-s128
Author(s):  
Taniece R. Eure ◽  
Nicola D. Thompson ◽  
Austin Penna ◽  
Wendy M. Bamberg ◽  
Grant Barney ◽  
...  
Keyword(s):  
Nursing Home ◽  
Urinary Tract ◽  
Nursing Homes ◽  
Treatment Guidelines ◽  
Nursing Home Residents ◽  
Antibiotic Use ◽  
Antibiotic Prescribing ◽  
Emerging Infections ◽  
Tract Infections ◽  
Uncomplicated Cystitis

Background: Antibiotics are among the most commonly prescribed drugs in nursing homes; urinary tract infections (UTIs) are a frequent indication. Although there is no gold standard for the diagnosis of UTIs, various criteria have been developed to inform and standardize nursing home prescribing decisions, with the goal of reducing unnecessary antibiotic prescribing. Using different published criteria designed to guide decisions on initiating treatment of UTIs (ie, symptomatic, catheter-associated, and uncomplicated cystitis), our objective was to assess the appropriateness of antibiotic prescribing among NH residents. Methods: In 2017, the CDC Emerging Infections Program (EIP) performed a prevalence survey of healthcare-associated infections and antibiotic use in 161 nursing homes from 10 states: California, Colorado, Connecticut, Georgia, Maryland, Minnesota, New Mexico, New York, Oregon, and Tennessee. EIP staff reviewed resident medical records to collect demographic and clinical information, infection signs, symptoms, and diagnostic testing documented on the day an antibiotic was initiated and 6 days prior. We applied 4 criteria to determine whether initiation of treatment for UTI was supported: (1) the Loeb minimum clinical criteria (Loeb); (2) the Suspected UTI Situation, Background, Assessment, and Recommendation tool (UTI SBAR tool); (3) adaptation of Infectious Diseases Society of America UTI treatment guidelines for nursing home residents (Crnich & Drinka); and (4) diagnostic criteria for uncomplicated cystitis (cystitis consensus) (Fig. 1). We calculated the percentage of residents for whom initiating UTI treatment was appropriate by these criteria. Results: Of 248 residents for whom UTI treatment was initiated in the nursing home, the median age was 79 years [IQR, 19], 63% were female, and 35% were admitted for postacute care. There was substantial variability in the percentage of residents with antibiotic initiation classified as appropriate by each of the criteria, ranging from 8% for the cystitis consensus, to 27% for Loeb, to 33% for the UTI SBAR tool, to 51% for Crnich and Drinka (Fig. 2). Conclusions: Appropriate initiation of UTI treatment among nursing home residents remained low regardless of criteria used. At best only half of antibiotic treatment met published prescribing criteria. Although insufficient documentation of infection signs, symptoms and testing may have contributed to the low percentages observed, adequate documentation in the medical record to support prescribing should be standard practice, as outlined in the CDC Core Elements of Antibiotic Stewardship for nursing homes. Standardized UTI prescribing criteria should be incorporated into nursing home stewardship activities to improve the assessment and documentation of symptomatic UTI and to reduce inappropriate antibiotic use.Funding: NoneDisclosures: None

scholarly journals Evaluation of Electronic Health Record and Long-Term Care Pharmacy Data for Tracking and Reporting Antibiotic Use in the United States

2021 ◽  
Vol 1 (S1) ◽  
pp. s13-s14
Author(s):  
Matthew Hudson ◽  
Katryna Gouin ◽  
Stanley Wang ◽  
Manjiri Kulkarni ◽  
Mary Beckerson ◽  
...  
Keyword(s):  
Nursing Home ◽  
Antibiotic Use ◽  
Data Sources ◽  
Short Stay ◽  
Term Care ◽  
Data Set ◽  
Pharmacy Data ◽  
Facility Level ◽  
Nursing Home Stay

Background: Antibiotics are frequently prescribed in nursing homes, often inappropriately. Data sources are needed to facilitate measurement and reporting of antibiotic use to inform antibiotic stewardship efforts. Previous analyses have shown that the type of nursing-home stay, that is, short stay (<100 days), is a strong predictor of high antibiotic use compared to longer nursing-home stays. The study objective was to compare 2 different data sources, electronic health record (EHR) and long-term care (LTC) pharmacy data, for surveillance of antibiotic use and type of nursing-home stay. Methods: EHR and pharmacy data during 2017 were included from 1,933 and 1,348 US-based nursing homes, respectively. We compared data elements available in each data source for antibiotic use reporting. In each data set, we attempted to describe antibiotic use as the proportion of residents on an antibiotic, days-of-therapy (DOT) per 1,000 resident days (RD), and distribution of antibiotic course duration, overall and at the facility level. Facility proportion of short-stay and long-stay (>100 days) nursing-home residents were calculated using admission dates and census data in the EHR data set and a payor variable in the pharmacy data set (Figure 1). The 2 data sources also provided antibiotic characteristics, including antibiotic class, agent, and route of administration. The deidentified nature of facility data prevented direct comparison of antibiotic use measures between facilities. Results: The EHR and pharmacy data sets contained 381,382 and 326,713 residents, respectively (Table 1). Within the EHR, 51% of residents were prescribed an antibiotic in 2017, at a median rate of 77 DOT per 1,000 RD. In the LTC pharmacy, 46% of residents were prescribed an antibiotic at a median rate of 79 DOT per 1,000 RD (Table 1). Short-stay residents contributed a smaller proportion of total RDs in the EHR relative to the pharmacy cohort (21% vs 50%, respectively). Conclusions: Nursing-home antibiotic use data obtained from EHR and pharmacy vendors can be used for calculating antibiotic use measures, which is important for antibiotic use reporting and facility-level tracking to identify opportunities for improving prescribing practices and provide facility-level benchmarks. Further validation of both data sources in the same facilities is needed to compare antibiotic use rates and to determine the most appropriate proxy for type of nursing-home stay for facility-level risk adjustment of antibiotic use rates.Funding: NoDisclosures: None

scholarly journals 91. Development of an Electronic Algorithm to Identify Inappropriate Antibiotic Prescribing for Pediatric Otitis Media

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S176-S177
Author(s):  
Ebbing Lautenbach ◽  
Jeffrey Gerber ◽  
Robert Grundmeier ◽  
Keith W Hamilton ◽  
Lauri Hicks ◽  
...  
Keyword(s):  
Electronic Health Record ◽  
Otitis Media ◽  
Chart Review ◽  
Antibiotic Use ◽  
Antibiotic Prescribing ◽  
Health Record ◽  
Test Characteristics ◽  
Academic Practices ◽  
Electronic Health ◽  
The Impact

Abstract Background Antibiotic stewardship (AS) interventions have primarily focused on acute care settings. The majority of antibiotic use, however, occurs in outpatients. The electronic health record (EHR) might provide an effective and efficient tool for outpatient AS. We aimed to develop and validate an electronic algorithm to identify inappropriate antibiotic use for pediatric outpatients with acute otitis media (AOM). Methods Within the Children’s Hospital of Philadelphia (CHOP) Care Network, we used ICD-10 diagnostic codes to identify patient encounters for AOM at any CHOP practice between 3/15/17 – 3/14/18. Exclusion criteria included underlying immunocompromising condition, comorbidities, and concurrent infections that might influence antibiotic use. We randomly selected 450 eligible subjects (150 each from academic practices, non-academic practices, and urgent care). Inappropriate antibiotic use based on CHOP and professional society guidelines were assessed via chart review and served as the basis for assessment of the electronic algorithm which was constructed using only data in the electronic health record (EHR). Criteria for appropriateness focused on the decision to prescribe, the choice of antibiotic, and duration of therapy. Results Of 450 subjects, median age was 2, 46% were female, and 88% were evaluated by a physician (vs. advanced practice provider). On chart review, the prescribing decision was correct in 438 (97%), of which 25 appropriately received no antibiotics. Of the 413 subjects who were appropriately prescribed an antibiotic, the choice of antibiotic was appropriate in 37 (9%). Finally, of the 413 patients who were appropriately treated, 412 (99.7%) received the correct duration. Test characteristics of the EHR algorithm (compared to chart review) are noted in the Table. Conclusion For children with AOM, an electronic algorithm for identification of inappropriate antibiotic prescribing is highly accurate. This algorithm can also highlight for which elements of prescribing the impact of an intervention might be greatest (i.e., choice of agent). Future work should validate this approach in other health systems and geographic regions and evaluate the impact of an audit and feedback intervention based on this tool. Table. Test Characteristics of Electronic Algorithm for Inappropriate Prescribing, Agent, and Duration Disclosures All Authors: No reported disclosures

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