Virtual learning collaboratives to improve urine culturing and antibiotic prescribing in long-term care: controlled before-and-after study. Issue 2 (14th April 2021)

• Record Type: Journal Article
• Authors: 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
• Is Part Of: BMJ quality & safety. Volume 31:Issue 2(2022)
• Page Start: 94
• Page End: 104
• Publication Date: 2021-04-14
• Subjects: nursing homes -- antibiotic management -- implementation science -- quality improvement; Medical care -- Quality control -- Periodicals; Health facilities -- Risk management -- Periodicals; Medical errors -- Prevention -- Periodicals; 362.106805
• DOI: 10.1136/bmjqs-2020-012226
• Languages: English
• ISSNs: 2044-5415

Abstract

Abstract : Background: 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. Methods: 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. Results: 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. Conclusions: 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.