RT Journal Article
SR Electronic
T1 Virtual learning collaboratives to improve urine culturing and antibiotic prescribing in long-term care: controlled before-and-after study
JF BMJ Quality & Safety
JO BMJ Qual Saf
FD BMJ Publishing Group Ltd
SP 94
OP 104
DO 10.1136/bmjqs-2020-012226
VO 31
IS 2
A1 Chambers, Andrea
A1 Chen, Cynthia
A1 Brown, Kevin Antoine
A1 Daneman, Nick
A1 Langford, Bradley
A1 Leung, Valerie
A1 Adomako, Kwaku
A1 Schwartz, Kevin L
A1 Moore, Julia E
A1 Quirk, Jacquelyn
A1 MacFarlane, Sam
A1 Cronsberry, Tim
A1 Garber, Gary E
YR 2022
UL http://qualitysafety.bmj.com/content/31/2/94.abstract
AB 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.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.