Journal article
B. Jones, Peter Taber, Jian Ying, Jorie M. Butler, M. Nevers, Makoto M. Jones, T. Greene, V. Stevens, S. Zickmund, C. Weir, M. Samore
Open Forum Infectious Diseases, 2021
Open Forum Infectious Diseases, 2021
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APA
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Jones, B., Taber, P., Ying, J., Butler, J. M., Nevers, M., Jones, M. M., … Samore, M. (2021). 1310. Provider and Facility Variation in Empiric Broad-Spectrum Antibiotic Use for Hospitalization Pneumonia: A Mixed Methods Study of Veterans Affairs Facilities. Open Forum Infectious Diseases.
Chicago/Turabian
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Jones, B., Peter Taber, Jian Ying, Jorie M. Butler, M. Nevers, Makoto M. Jones, T. Greene, et al. “1310. Provider and Facility Variation in Empiric Broad-Spectrum Antibiotic Use for Hospitalization Pneumonia: A Mixed Methods Study of Veterans Affairs Facilities.” Open Forum Infectious Diseases (2021).
MLA
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Jones, B., et al. “1310. Provider and Facility Variation in Empiric Broad-Spectrum Antibiotic Use for Hospitalization Pneumonia: A Mixed Methods Study of Veterans Affairs Facilities.” Open Forum Infectious Diseases, 2021.
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@article{b2021a,
title = {1310. Provider and Facility Variation in Empiric Broad-Spectrum Antibiotic Use for Hospitalization Pneumonia: A Mixed Methods Study of Veterans Affairs Facilities},
year = {2021},
journal = {Open Forum Infectious Diseases},
author = {Jones, B. and Taber, Peter and Ying, Jian and Butler, Jorie M. and Nevers, M. and Jones, Makoto M. and Greene, T. and Stevens, V. and Zickmund, S. and Weir, C. and Samore, M.}
}
Abstract
Abstract Background We previously found widespread variation in the empiric use of antibiotics against methicillin-resistant Staph aureus (anti-MRSA) and Pseudomonas aeruginosa (anti-PAER) for patients hospitalized for pneumonia. To explore this variation further, we conducted (1) quantitative analyses of facility-level versus provider-level variation, and (2) qualitative interviews with emergency department providers. Methods For each hospitalization, we predicted the probability of anti-MRSA and anti-PAER use by fitting machine learning models from 75 patient variables. We estimated the predicted risk of anti-MRSA/anti-PAER and facility features among patients hospitalized at upper versus lower 10% facilities after controlling for patient characteristics. We plotted density curves with the variance attributed to facility and provider alone and together. We then interviewed 16 emergency department (ED) providers at 8 VA facilities using a cognitive task analysis. Results Among 215,803 hospitalizations at 128 VA facilities 1/1/2006-12/31/2016, 31% received empiric anti-MRSA and 29% received empiric anti-PAER antibiotics. Hospitalizations at upper-decile facilities had a 50% and 45% adjusted probability of receiving anti-MRSA and anti-PAER antibiotics, compared to 15% and 20% in the lower-decile facilities. Facility features most predictive of anti-MRSA or anti-PAER use after adjusting for patient characteristics were complexity level (33% and 30% in high versus 15% and 20% in low complexity facilities). Variation in empiric anti-MRSA and anti-PAER use was almost completely at the facility level (Figure 1). Providers reported social influences from the opinions of other providers during decision-making and a high trust in guidelines and order sets. Consideration of pathogens was not mentioned by any providers at high-prescribing facilities. Conclusion Variation in empiric use of anti-MRSA and anti-PAER antibiotics in pneumonia clustered nearly completely at the facility level. ED providers report social influences during decision-making and a high trust in guidelines and order sets. Guidelines, order sets, and facility-level clinical champions that promote consideration of pathogens could be important strategies for de-adoption. Disclosures All Authors: No reported disclosures
