Audit-and-feedback to Improve Antimicrobial-prescribing Among Urologists

NCT04196777 | Completed Results

• 1 other identifier: 201911105
• Study Type: interventional
• Target: 525
• Locations: 1 country
• Sites: 3

Brief Summary

Antimicrobial resistance is one of today''s most urgent public health problems. An important strategy to slow the spread of antimicrobial resistance is the promotion of judicious antimicrobial use. There are many opportunities to reduce unnecessary antimicrobial-prescribing, including in patients undergoing surgical procedures. The following study will specifically study opportunities to improve antimicrobial use in patients undergoing common urologic procedures at hospitals in the Veterans Health Administration (VHA). Guidelines recommend giving antibiotics for no more than 24-hours after most urologic procedures, but the investigators have shown that the unnecessary use of post-procedural antimicrobials is common in this setting. In a national cohort of nearly 30,000 VHA patients, excessive post-procedural antimicrobials were prescribed after 37.2% of urologic procedures for a median duration of 3.0 excess days. In this study, the investigators will evaluate whether giving regular feedback to providers at 3 VHA hospitals can reduce unnecessary antimicrobial use after urologic procedures.

Conditions

Urologic Diseases; Antibacterial Drug Adverse Reaction

Keywords

anti-bacterial

Outcome Measures

Primary Outcomes (1)

• Percentage of Cases Who Received Excessive Post-procedural Antimicrobials

  Excessive post-procedural antimicrobial use is defined as a prescription for a antimicrobial agent on post-procedural day one. For this specific outcome measure, the numerator will be the number of patients who received an excessive post-procedural antimicrobial, and the denominator will be all patients at the site who underwent a qualifying urologic procedure.

  Within 1 day of the urologic procedure

Secondary Outcomes (6)

• Excessive Post-procedural Antimicrobial Duration (Mean)

  Within 30-days of the urologic procedure

• Percentage of Cases Who Received a Late Antimicrobial Prescription

  Within 30-days of the urologic procedure

• Percentage of Cases Who Were Re-admitted to the Hospital or Presented to an Emergency Department or an Urgent Care Clinic

  Within 30-days of the urologic procedure

• Percentage of Cases Who Died (Mortality)

  Within 30-days of the urologic procedure

• Percentage of Cases Who Underwent Clostridioides Difficile Testing

  Within 30-days of the urologic procedure

Study Arms (1)

Intervention

EXPERIMENTAL

We will randomly select 3 intervention sites from the top quartile of all VHA sites, as ranked by the frequency of excessive post-procedural antimicrobial use after the 3 urologic procedures of interest. We will provide feedback both at baseline and at regular intervals to the 3 intervention sites. Data on hospital-level excessive post-procedural antimicrobial use specific to urologic patients (primary outcome) will be shared at baseline with the intervention sites. Updated data will be sent electronically to urology providers and the antimicrobial stewardship team at the intervention site every other month via electronic mail. These data will include an anonymous comparison to all other VHA hospitals.

Behavioral: Audit-and-feedback

Interventions

Audit-and-feedback BEHAVIORAL

We will provide feedback both at baseline and at regular intervals to the 3 intervention sites. At first, we will schedule one-on-one conference calls with urology providers and the antimicrobial stewardship team at each of the 3 intervention sites. These conference calls will include a review of guidelines, a review of the facility's data on excessive post-procedural antimicrobial use for urologic patients, and an anonymous comparison to all other VHA sites. Next, we will prospectively monitor excessive post-procedural antimicrobial use at all 3 sites and the entire VHA for 1 year. Data on hospital-level excessive post-procedural antimicrobial use specific to urologic patients (primary outcome) will be sent electronically to urology providers and the antimicrobial stewardship team at the intervention site every other month via electronic mail.

Intervention

Eligibility Criteria

• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Child (0-17), Adult (18-64), Older Adult (65+)

You may qualify if:

• A practicing urologist at an intervention site, OR
• A member of the antimicrobial stewardship team at an intervention site

Sponsors & Collaborators

• Iowa City Veterans Affairs Medical Center: lead
• Merck Sharp & Dohme LLC: collaborator

Study Sites (3)

VA North Florida/South Georgia Veterans Health System

Gainesville, Florida, 32608-1135, United States

Location

Iowa City VA Medical Center

Iowa City, Iowa, 52246, United States

Location

VA New York Harbor Healthcare System (Brooklyn)

New York, New York, 10010, United States

Location

Related Publications (1)

• Livorsi DJ, Packiam VT, Shi Q, Alberding SY, Carter KD, Brown JA, Mason JB, Weiss JP, Steinberg RL. A pilot intervention trial to reduce the use of post-procedural antimicrobials after common endourologic surgeries. Infect Control Hosp Epidemiol. 2024 Nov 7;46(1):1-7. doi: 10.1017/ice.2024.172. Online ahead of print.

  PMID: 39506499 DERIVED

MeSH Terms

Conditions

Urologic Diseases

Condition Hierarchy (Ancestors)

Female Urogenital Diseases; Female Urogenital Diseases and Pregnancy Complications; Urogenital Diseases; Male Urogenital Diseases

Results Point of Contact

• Title: Daniel Livorsi
• Organization: Iowa City VA Health Care System

daniel.livorsi@va.gov

319-688-3871

Publication Agreements

• PI is Sponsor Employee: No
• Restrictive Agreement: No

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: NA
• Masking: NONE
• Purpose: HEALTH SERVICES RESEARCH
• Intervention Model: SINGLE GROUP
• Sponsor Type: FED
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Principal investigator

Model Details: The behavioral intervention will be delivered at 3 intervention hospitals.

Study Record Dates

• First Submitted: December 3, 2019
• First Posted: December 12, 2019
• Study Start: August 1, 2022
• Primary Completion: July 31, 2023
• Study Completion: August 31, 2023
• Last Updated: September 19, 2024
• Results First Posted: September 19, 2024

Record last verified: 2024-08

Data Sharing

• IPD Sharing: Will not share

Locations

US (3)