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COMPASS study (COMPuterized Antibiotic Stewardship Study)

English title COMPASS study (COMPuterized Antibiotic Stewardship Study)
Applicant Huttner Benedikt
Number 167079
Funding scheme NRP 72 Antimicrobial Resistance
Research institution Service des Maladies Infectieuses Département de Médecine Interne Hôpital Cantonal - HUG
Institution of higher education University of Geneva - GE
Main discipline Infectious Diseases
Start/End 01.03.2017 - 28.02.2021
Approved amount 405'600.00
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All Disciplines (7)

Discipline
Infectious Diseases
Medical Microbiology
Internal Medicine
Surgery
Methods of Epidemiology and Preventive Medicine
Information Technology
Geriatrics

Keywords (6)

Cluster randomized trial; Audit and feedback; Antibiotic use; Antibiotic indicators; Antibiotic stewardship; Computerized decision support

Lay Summary (German)

Lead
Wir integrieren direkt im elektronischen Patientendossier ein Tool, um Spitalärzten Rückmeldungen zu ihren Antibiotikaverschreibungen zu geben. Dieses System erproben wir im Klinikalltag.
Lay summary

Die Verschreibung von Antibiotika stellt in der Praxis oft Probleme: Nicht immer erhalten Patienten das richtige Antibiotikum, in der richtigen Dosierung, für die richtige Dauer. Das fördert die Entstehung und Verbreitung von Antibiotikaresistenzen. Wir entwickeln ein System, das Ärzten helfen soll, Antibiotika gezielter einzusetzen. In unserer COMPASS-Studie (COMPuterized Antibiotic Stewardship Study) erhalten Ärzte in drei Schweizer Spitälern Hinweise für den Gebrauch von Antibiotika, die direkt im elektronischen Patientendossier integriert sind. Dazu bekommen sie regelmässig Rückmeldungen über ihren Antibiotikagebrauch. Parallel erheben wir die Verschreibungspraxis in einer Kontrollgruppe, die dieses System nicht nutzt. So können wir dessen Wirksamkeit überprüfen.

Hintergrund
Der rationale Gebrauch von Antibiotika ist eine der wichtigsten Massnahmen, um die Entstehung und Verbreitung resistenter Keime zu verhindern und einzudämmen. Wirksame, kosteneffiziente und nachhaltige Methoden, den Antibiotikagebrauch durch Ärzte zu verbessern, werden dringend benötigt.

Ziel
Wir wollen herauszufinden, ob Krankenhausärzte durch in die elektronische Krankenakte integrierte Hilfsmodule dazu bewegt werden können, Antibiotika besser zu verschreiben.

Bedeutung
Wenn sich unser System bewährt, steht damit ein Instrument zur Verfügung, um Antibiotika in Spitälern gezielter einzusetzen und so Antibiotikaresistenzen einzudämmen.

Direct link to Lay Summary Last update: 05.12.2017

Lay Summary (French)

Lead
Nous intégrons directement au dossier électronique du patient un outil permettant de fournir aux médecins hospitaliers un retour d’informations sur les prescriptions d’antibiotiques. Nous testons ce système dans la pratique clinique quotidienne.
Lay summary

Les patients en milieu hospitalier ne reçoivent pas toujours le bon antibiotique au bon dosage sur la bonne durée. Ceci contribue à l’apparition et à la propagation de résistances. Nous développons un système adapté dans le but d’aider les médecins à utiliser les antibiotiques de façon plus ciblée. Lors de notre étude COMPASS (COMPuterized Antibiotic Stewardship Study), les médecins de trois hôpitaux suisses reçoivent des recommandations sur l’utilisation des antibiotiques, lesquelles sont directement intégrées au dossier électronique du patient. Des comptes-rendus leur sont également régulièrement fournis sur leurs prescriptions. Parallèlement, nous recueillons les données de prescription dans un groupe de contrôle n’employant pas ce système afin de vérifier son efficacité.

Contexte
L’usage rationnel des antibiotiques est l’une des mesures les plus importantes permettant d’éviter et d’endiguer l’apparition et la propagation de germes résistants. Il est urgent que des méthodes efficaces, productives et durables soient élaborées afin d’optimiser l’utilisation des antibiotiques par les médecins.

Objectif
Nous souhaitons déterminer si les médecins hospitaliers peuvent être incités à prescrire les antibiotiques de manière plus ciblée grâce à des modules d’assistance intégrés au dossier électronique du patient.

Importance
Si notre système s’avère efficace, les hôpitaux auront à disposition un instrument permettant d’employer les antibiotiques de manière plus ciblée et d’endiguer ainsi le développement de résistances.


Direct link to Lay Summary Last update: 05.12.2017

Lay Summary (English)

Lead
We are integrating a tool directly into the electronic health recrod to give hospital doctors feedback on the way they prescribe antibiotics. This system is being trialled in various hospitals.
Lay summary

Prescribing antibiotics frequently poses problems in practice, since patients don’t always receive the right dosage of the right antibiotic for the right period of time. This promotes the emergence and spread of antibiotic resistance. We are developing a system designed to help doctors to use antibiotics more appropriately. Under COMPASS (COMPuterized Antibiotic Stewardship Study), doctors in three Swiss hospitals will receive tips on the use of antibiotics that are integrated directly into electronic health record. They will also be given regular feedback on their use of antibiotics. Parallel to this, we will collect data on the antimicrobial prescription practices of a control group which is not using the system so that we can monitor the latter’s effectiveness.

Background
The judicious use of antibiotics is one of the key ways to prevent and keep in check the emergence and spread of resistant germs. There is an urgent need for effective, cost-efficient and sustainable methods to improve the way doctors use antibiotics.

Aim
We aim to find out whether decision-aid modules integrated into electronic patient files can help in encouraging hospital doctors to improve the way they prescribe antibiotics. .

Relevance
Should our system prove a success, it could be a tool to use antibiotics more appropriately in hospitals in order to keep antibiotic resistance in check.


Direct link to Lay Summary Last update: 05.12.2017

Responsible applicant and co-applicants

Employees

Publications

Publication
Study protocol for a multicentre, cluster randomised, superiority trial evaluating the impact of computerised decision support, audit and feedback on antibiotic use: the COMPuterized Antibiotic Stewar
(2018), Study protocol for a multicentre, cluster randomised, superiority trial evaluating the impact of computerised decision support, audit and feedback on antibiotic use: the COMPuterized Antibiotic Stewar, in BMJ Open, 1-9.

Collaboration

Group / person Country
Types of collaboration
EOC Ticino Switzerland (Europe)
- in-depth/constructive exchanges on approaches, methods or results
- Publication
- Research Infrastructure

Scientific events

Active participation

Title Type of contribution Title of article or contribution Date Place Persons involved
Gemeinsame Jahrestagung SGI | SGInf | SGSH | SGTP | SGTRM Poster How to develop and implement a computerized decision support system integrated with electronic prescribing for antimicrobial stewardship? Experience from two Swiss hospital systems. 18.09.2019 Lausanne, Switzerland Pagnamenta Francesco; Valotti Roberta; Bernasconi Enos; Catho Gaud; Huttner Benedikt;
ECCMID Poster P1934 How to develop and implement a computerised decision support system integrated into the electronic prescribing for antimicrobial stewardship? Experience from two Swiss hospital systems 13.04.2019 Ansterdam, Netherlands Catho Gaud; Pagnamenta Francesco; Portela Javier; Valotti Roberta; Huttner Benedikt; Bernasconi Enos; Meyer Rodolphe;


Associated projects

Number Title Start Funding scheme
180215 A digital antimicrobial stewardship smartphone application to combat AMR: the AB-assistant 01.02.2018 Joint Programming Initiative on Antimicrobial Resistance (JPIAMR)

Abstract

We propose a multicentre cluster-randomised controlled superiority trial of a multimodal computerised decision-support system (CDSS) integrated into the electronic health record (EHR) to improve antibiotic use. Acute-care wards in three Swiss hospitals (Geneva, Lugano, Bellinzona) will be randomized 1:1 to either standard of care or a multimodal CDSS intervention consisting of computerized decision-support for empiric antimicrobial use, systematic reassessment of empiric treatment on day four of antibiotic treatment and automated feedback of quality indicators throughout the 12-month intervention period. The primary outcome will be the reduction of overall antibiotic use, as measured by days of therapy per hospital admission. Secondary outcomes will be the impact of the CDSS on antibiotic prescribing quality, economic outcomes and patient-related outcomes, including possible inadvertent outcomes such as changes in mortality, intensive care unit admission or readmissions. One of the strategies that will be encouraged by the intervention is antibiotic de-escalation, yet the impact of this strategy on antimicrobial resistance is unclear. We therefore propose a sub-study that aims to assess the impact of antibiotic de-escalation on the human intestinal microbiome and antibiotic resistance gene abundance using a propensity score matched case-control study nested in a prospective cohort study.
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