Michigan Hospital Group Seeks to Improve Antibiotic Prescribing at Discharge

Sept. 1, 2023
Members of the Michigan Hospital Medicine Safety Consortium are engaging in a 40-hospital trial of an effort to reduce overuse of antibiotics at discharge

Members of the Michigan Hospital Medicine Safety Consortium (HMS) are engaging in a 40-hospital trial to evaluate a new strategy to improve antibiotic prescribing at hospital discharge.

The federal Agency for Healthcare Research (AHRQ) has awarded $2.5 million in research funding to the study “Reducing Overuse of Antibiotics at Discharge: The ROAD Home Trial.”

Antibiotic overuse at hospital discharge is common and increases the risk of side effects to patients after they leave the hospital. In the U.S., antibiotics prescribed at discharge account for half of antibiotic use—and up to 90 percent of days of overuse—related to hospitalization. While there are interventions that have been successful at improving the way antibiotics are prescribed at discharge, these interventions require resources (such as infectious diseases-trained personnel) that are not available at all hospitals, such as rural hospitals. There’s a large need to help all hospitals—not just those with more resources—improve antibiotic prescribing.

To address this need, the ROAD Home study team developed the ROAD Home intervention to improve antibiotic prescribing at discharge. Rather than a “one-size-fits-all” approach, the ROAD Home intervention tailors strategies to improve antibiotic prescribing at discharge to the needs and resources of local hospitals. The ROAD Home Intervention includes three components. First, the ROAD Home study team will identify current needs, priorities, and resources related to antibiotic prescribing at discharge. Second, the ROAD Home study team will work with hospitals to build a customized toolbox to improve prescribing. Finally, the ROAD Home study team will work with hospitals to put these tools into practice.

The trial will leverage the strength of HMS, which includes 69 hospitals working to improve care for hospitalized patients. Together with HMS, the ROAD Home trial will inform broad national dissemination efforts to ensure that reductions in harm and improvements in quality due to antibiotic stewardship are equitably distributed, reaching all patients regardless of where they receive care.

“Antibiotics prescribed at discharge account for half of antibiotic days prescribed to hospitalized adults with infections. Yet up to 70 percent of discharge prescriptions are not guideline-concordant. Antibiotic stewardship is one of the key areas HMS strongly supports; thus, this study and the content area are extremely relevant to HMS hospitals,” said Tejal Gandhi, M.D., HMS antimicrobial physician lead, in a statement.

The ROAD Home project is an extension of the quality improvement initiatives HMS has been focusing on related to diagnosis and treatment of pneumonia and urinary tract infection since 2017. As part of the grant, the team will develop a ROAD Home discharge stewardship toolkit that will be distributed to all Michigan hospitals.

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