Pharmacy Department, 23264Saint Barnabas Medical Center, Livingston, NJ, USA.
Pharmacy Department, 24051Community Medical Center, Toms River, NJ, USA.
J Pharm Pract. 2022 Jun;35(3):403-406. doi: 10.1177/0897190020987130. Epub 2021 Jan 12.
Limited sample size and disparate outcome measures can hinder the ability of antimicrobial stewardship programs to assess the utility of their quality improvement interventions. Desirability of outcome ranking (DOOR) is a novel methodology that incorporates multiple outcomes into a single value to more comprehensively compare therapeutic strategies. The objective of this study was to apply DOOR to a single center antibiotic stewardship intervention.
A pre- and post-interventional study was conducted evaluating the impact of prospective pharmacist review of rapid molecular diagnostic testing (RDT) of blood cultures on antibiotic optimization. Outcomes included the percentage of patients who were switched to appropriate therapy, the time to appropriate therapy, and the percentage of patients who had missed de-escalation opportunities.
A total of 19 and 29 patients were included in the final analysis. The percentage of patients reaching appropriate therapy was 84% (16/19) and 97% ([28/29], p = 0.16) in the pre-intervention and post-intervention groups respectively. Median time to appropriate therapy was 26 hours and 36 minutes (IQR 13:05-50:45) and 22:40 (IQR 3:42-48:23, p = 0.32), respectively. One missed de-escalation opportunity was identified in the post-intervention group (0% vs 3%, p = 1.00). DOOR analysis indicated that the probability of a better outcome for the post-intervention group than the pre-intervention group was 58% (95% CI 54-62).
In this analysis, DOOR revealed a benefit that would not have been apparent with traditional outcomes assessments. Antimicrobial stewardship programs conducting quality improvement studies should consider incorporating DOOR into their methodology.
有限的样本量和不同的结果测量方法可能会阻碍抗菌药物管理计划评估其质量改进干预措施效果的能力。结果排序的期望（DOOR）是一种新的方法学，它将多个结果整合到一个单一的数值中，以更全面地比较治疗策略。本研究的目的是将 DOOR 应用于单个中心的抗生素管理干预。
进行了一项前瞻性和回顾性研究，评估了对快速分子诊断检测（RDT）血液培养物进行前瞻性药师审查对抗生素优化的影响。结果包括达到适当治疗的患者百分比、达到适当治疗的时间和错过降级机会的患者百分比。
共纳入 19 例和 29 例患者进行最终分析。在干预前和干预后组中，达到适当治疗的患者百分比分别为 84%（16/19）和 97%（[28/29]，p=0.16）。达到适当治疗的中位数时间分别为 26 小时和 36 分钟（IQR 13：05-50：45）和 22:40（IQR 3：42-48:23，p=0.32）。干预后组发现有 1 例错过降级机会（0% vs 3%，p=1.00）。DOOR 分析表明，干预后组的结果优于干预前组的概率为 58%（95%CI 54-62）。
在本分析中，DOOR 揭示了一种与传统结果评估相比具有优势的结果。进行质量改进研究的抗菌药物管理计划应考虑将 DOOR 纳入其方法学。
