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Patient-Centered Stewardship to Improve Antibiotic Use in Ambulatory Care

Award Number: R01HS029328
ORGANIZATION: AGENCY FOR HEALTH CARE RESEARCH AND QUALITY
OPDIV: AHRQ
AWARD CLASS: DISCRETIONARY
AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)
PERIOD OF PERFORMANCE START DATE: 09/30/2023
PERIOD OF PERFORMANCE END DATE: 07/31/2028

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Patient-Centered Stewardship to Improve Antibiotic Use in Ambulatory Care - Background: Antibiotic overuse threatens patient safety by causing adverse effects and threatens the effectiveness of antibiotics through the development of antibiotic resistance. Although our research team and others have been successful in improving antibiotic prescribing during office visits using behavioral economics and communication strategies, the improvements have generally been modest and generally focus on clinician behavior. Patient-directed interventions have usually been visit-based, educational, and generic. We have written about a need for patient-centered stewardship, which would use a theory-informed approach to engage directly with high- inappropriate-antibiotic-utilizing patients outside of visits about their own concerns and behavior. Research Strategy: To understand and address high-inappropriate patient antibiotic use, we will conduct a mixed-methods project including controlled cohort studies, qualitative analyses, and a pilot randomized controlled trial (RCT) of a patient-centered behavioral nudge. Specific Aim 1 is to perform retrospective, patient-focused, controlled cohort studies of adults and children in 2 health systems (over 1.5 million patients) to categorize high-antibiotic-use as appropriate, partially appropriate, potentially appropriate, and inappropriate. Specific Aim 2 is to conduct qualitative interviews with high inappropriate-antibiotic-utilizing patients to identify social and behavioral factors that influence care-seeking and antibiotic use, informed by the Theoretical Domains Framework (TDF) framework. Specific Aim 3 is to – based on findings from Aims 1 and 2 – develop, refine, and evaluate in a controlled pilot RCT the impact of a patient-centered stewardship behavioral nudge intervention to reduce inappropriate antibiotic use among high-antibiotic-utilizing patients. The primary outcome will be the number of inappropriate antibiotic prescriptions over 8 months. Secondary outcomes will include non-antibiotic medication prescribing, implementation outcomes (feasibility and acceptability), spillover effects, and unintended consequences. Implications and Future Directions: We seek to understand and intervene on patient care-seeking and inappropriate antibiotic use. This project will lay the groundwork for a future, larger RCT testing the effectiveness of components of the intervention in a broader patient population. The ultimate goals of this project and subsequent interventions and evaluations are to better understand patient concerns, care-seeking, and antibiotic use; enable effective engagement with care; improve diagnostic accuracy; and ensure antibiotic prescribing quality to improve patient safety, decrease adverse drug events, and limit the spread of antibiotic resistant bacteria.


Issue Date FY	Funding FY	Legal Entity Name	Legal Entity Address	Legal Entity City	Legal Entity State	Legal Entity Zip Code	Legal Entity COUNTY	Legal Entity COUNTRY	Assistance Listing	Award Code	Budget Year	Action Date	Action Type	Action Amount

Issue Date FY: 2026 ( Subtotal = $476,455 )
2026	2026	NORTHWESTERN UNIVERSITY	633 CLARK ST	EVANSTON	IL	60208	COOK	USA	Research on Healthcare Costs, Quality and Outcomes	000	4	9/4/2026	NON-COMPETING CONTINUATION	$476,455
														Subtotal = $476,455

Issue Date FY: 2025 ( Subtotal = $485,685 )
2025	2025	NORTHWESTERN UNIVERSITY	633 CLARK ST	EVANSTON	IL	60208	COOK	USA	Research on Healthcare Costs, Quality and Outcomes	000	3	9/29/2025	NON-COMPETING CONTINUATION	$485,685
														Subtotal = $485,685

Issue Date FY: 2024 ( Subtotal = $495,487 )
2024	2024	NORTHWESTERN UNIVERSITY	633 CLARK ST	EVANSTON	IL	60208	COOK	USA	Research on Healthcare Costs, Quality and Outcomes	001	2	6/13/2024	NON-COMPETING CONTINUATION	$495,487
2024	2023	NORTHWESTERN UNIVERSITY	633 CLARK ST	EVANSTON	IL	60208	COOK	USA	Research on Healthcare Costs, Quality and Outcomes	000	1	5/31/2024	NEW	$0
														Subtotal = $495,487

Issue Date FY: 2023 ( Subtotal = $500,000 )
2023	2023	NORTHWESTERN UNIVERSITY	633 CLARK ST	EVANSTON	IL	60208	COOK	USA	Research on Healthcare Costs, Quality and Outcomes	000	1	9/12/2023	NEW	$500,000
														Subtotal = $500,000

Grand Total All Awards = $1,957,627

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Patient-Centered Stewardship to Improve Antibiotic Use in Ambulatory Care

Award Number: R01HS029328

ORGANIZATION: AGENCY FOR HEALTH CARE RESEARCH AND QUALITY

OPDIV: AHRQ

AWARD CLASS: DISCRETIONARY

AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

PERIOD OF PERFORMANCE START DATE: 09/30/2023

PERIOD OF PERFORMANCE END DATE: 07/31/2028

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