Article Text

Virtual learning collaboratives to improve urine culturing and antibiotic prescribing in long-term care: controlled before-and-after study
  1. Andrea Chambers1,
  2. Cynthia Chen1,2,
  3. Kevin Antoine Brown1,2,3,
  4. Nick Daneman1,2,4,
  5. Bradley Langford1,
  6. Valerie Leung1,
  7. Kwaku Adomako1,
  8. Kevin L Schwartz1,3,
  9. Julia E Moore5,
  10. Jacquelyn Quirk1,
  11. Sam MacFarlane1,
  12. Tim Cronsberry1,
  13. Gary E Garber1,6
  1. 1 Public Health Ontario, Toronto, Ontario, Canada
  2. 2 ICES, Toronto, Ontario, Canada
  3. 3 Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
  4. 4 Division of Infectious Diseases, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
  5. 5 Center for Implementation, Toronto, Ontario, Canada
  6. 6 Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
  1. Correspondence to Dr Andrea Chambers, Public Health Ontario, Toronto M5G 1V2, Canada; Andrea.Chaplin{at}oahpp.ca

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.

  • nursing homes
  • antibiotic management
  • implementation science
  • quality improvement

Data availability statement

Data are available on reasonable request. Data may be obtained from a third party and are not publicly available. Survey data for the process measures is available on reasonable request. The dataset from this study is held securely in coded form at ICES. While data sharing agreements prohibit ICES from making the dataset publicly available, access may be granted to those who meet prespecified criteria for confidential access, available at www.ices.on.ca/DAS. The full dataset creation plan and underlying analytic code are available from the authors on request, understanding that the computer programs may rely on coding templates or macros that are unique to ICES and are therefore either inaccessible or may require modification.

http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

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Data availability statement

Data are available on reasonable request. Data may be obtained from a third party and are not publicly available. Survey data for the process measures is available on reasonable request. The dataset from this study is held securely in coded form at ICES. While data sharing agreements prohibit ICES from making the dataset publicly available, access may be granted to those who meet prespecified criteria for confidential access, available at www.ices.on.ca/DAS. The full dataset creation plan and underlying analytic code are available from the authors on request, understanding that the computer programs may rely on coding templates or macros that are unique to ICES and are therefore either inaccessible or may require modification.

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Footnotes

  • Contributors AC led the design of the study and contributed to analysis and interpretation of data. GG provided overall supervision, contributed to the study design and interpretation of data. CC conducted the statistical analysis of the outcome data. KA contributed to the design of the study, provided coordination support to access the data and contributed to analysis and interpretation of data. KB, ND, BL, VL, KS, JEM, JQ, SM and TC contributed expertise to the study design and interpretation of data. All authors contributed to drafting and revising the article, and final approval of the version for submission.

  • Funding This study was conducted with Public Health Ontario operational funds. This study was also supported by ICES, which is funded by an annual grant from the Ontario Ministry of Health and Long-term Care (MOHLTC). Parts of this material are based on data and/or information compiled and provided by the Canadian Institute for Health Information (CIHI). The opinions, results and conclusions reported in this paper are those of the authors and are independent from the funding sources. No endorsement by ICES, CIHI or the Ontario MOHLTC is intended or should be inferred.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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