Chambers Andrea, Chen Cynthia, Brown Kevin Antoine, Daneman Nick, Langford Bradley, Leung Valerie, Adomako Kwaku, Schwartz Kevin L, Moore Julia E, Quirk Jacquelyn, MacFarlane Sam, Cronsberry Tim, Garber Gary E
Public Health Ontario, Toronto, Ontario, Canada
Public Health Ontario, Toronto, Ontario, Canada.
BMJ Qual Saf. 2022 Feb;31(2):94-104. doi: 10.1136/bmjqs-2020-012226. Epub 2021 Apr 14.
Urine culturing practices are highly variable in long-term care and contribute to overprescribing of antibiotics for presumed urinary tract infections. The purpose of this study was to evaluate the use of virtual learning collaboratives to support long-term care homes in implementing a quality improvement programme focused on reducing unnecessary urine culturing and antibiotic overprescribing.
Over a 4-month period (May 2018-August 2018), 45 long-term care homes were self-selected from five regions to participate in virtual learning collaborative sessions, which provided an orientation to a quality improvement programme and guidance for implementation. A process evaluation complemented the use of a controlled before-and-after study with a propensity score matched control group (n=127) and a difference-in-difference analysis. Primary outcomes included rates of urine cultures performed and urinary antibiotic prescriptions. Secondary outcomes included rates of emergency department visits, hospital admission and mortality. An 18-month baseline period was compared with a 16-month postimplementation period with the use of administrative data sources.
Rates of urine culturing and urinary antibiotic prescriptions per 1000 resident days decreased significantly more among long-term care homes that participated in learning collaboratives compared with matched controls (differential reductions of 19% and 13%, respectively, p<0.0001). There was no statistically significant changes to rates of emergency department visits, hospital admissions or mortality. These outcomes were observed with moderate adherence to the programme model.
Rates of urine culturing and urinary antibiotic prescriptions declined among long-term care homes that participated in a virtual learning collaborative to support implementation of a quality improvement programme. The results of this study have refined a model to scale this programme in long-term care.
长期护理机构中的尿液培养操作差异很大，这导致了对疑似尿路感染过度开具抗生素。本研究的目的是评估虚拟学习协作的作用，以支持长期护理机构实施一项旨在减少不必要尿液培养和抗生素过度开具的质量改进计划。
在2018年5月至2018年8月的4个月期间，从五个地区自行选择了45家长期护理机构参加虚拟学习协作会议，这些会议提供了质量改进计划的介绍以及实施指导。采用过程评估对倾向得分匹配对照组（n = 127）的前后对照研究及差异分析进行补充。主要结局包括尿液培养率和泌尿系统抗生素处方率。次要结局包括急诊就诊率、住院率和死亡率。使用行政数据源将18个月的基线期与实施后的16个月进行比较。
与匹配的对照组相比，参与学习协作的长期护理机构中每1000个居民日的尿液培养率和泌尿系统抗生素处方率显著下降更多（分别下降19%和13%，p<0.0001）。急诊就诊率、住院率或死亡率没有统计学上的显著变化。这些结果是在适度遵守计划模型的情况下观察到的。
参与虚拟学习协作以支持质量改进计划实施的长期护理机构中，尿液培养率和泌尿系统抗生素处方率有所下降。本研究结果完善了一个模型，以便在长期护理中推广该计划。
