Uptake and Utilization of a Mobile Application Decision Support Tool to Enhance Antimicrobial Stewardship in Colorado
Authors: Dimo Joana , Weber Matthew J , Miller Matthew A , Bozzella Michael J , Bakel Leigh Anne , Jenkins Timothy , Parker Sarah K 
Published: January 2025

Abstract

Corresponding Author: Joana Dimo, DO, Department of Pediatrics, Division of Infectious Diseases, University of Colorado, 13123 East 16th Avenue, Box 055, Aurora, CO 80045, USA. 216-210-4687, joana.dimo@childrenscolorado.org
Alternate Corresponding Author: Sarah K Parker, MD, Department of Pediatrics, Division of Infectious Diseases, University of Colorado, 13123 East 16th Avenue, Box 055, Aurora, CO 80045, USA, (720) 777-8811, sarah.parker@childrenscolorado.org
Funding: This work was supported by the Pfizer Global Medical Grants and Global Bridges at Mayo Clinic (grant number 70956251) and through a contract with the Colorado Department of Public Health and Environment (CDPHE).
No conflicts of interest

Background
Previous collaborative work with Children’s Hospital Colorado (Children’s Colorado) and the Colorado Department of Public Health and Environment (CDPHE) uncovered several self-identified barriers to antimicrobial stewardship (ASP) in various Colorado hospitals (n=100), with the most significant being lack of clinical pathways, lack of antibiotic dosing knowledge in the neonatal and pediatric populations, and lack of understanding of stewardship methodologies. We sought to mitigate barriers to robust ASP among Colorado hospitals through implementation and dissemination of a mobile application decision support system, Firstline ( www.Firstline.org ). Our objective is to describe the uptake and usage patterns of Firstline across the state.

Methods
ASP teams at Children’s Colorado and Denver Health partnered with Firstline to develop the mobile application. Children’s Colorado and Denver Health teams provided neonatal/pediatric and adult guidance respectively. Content featured in the app includes, 1) facility-specific clinical pathways, 2) pathogen information, 3) antimicrobial dosing and monitoring, and 4) infection prevention and ASP resources. The Children’s Colorado platform went live October 10th, 2023, and Denver Health on October 31st, 2023. Firstline provided analytic data on the number of users and usage patterns. The Children’s Colorado Physician Relations team (data from Definitive Healthcare Database) and the Colorado Department of Regulatory Agencies (DORA) Professional and Occupational Licenses Information Marketplace provided Practitioner data.

Results
3287 total unique mobile users accessed Children’s Colorado or Denver Health Firstline from launch through end of April 2024. There were 718 average monthly active users (Figure 1), primarily physicians in an inpatient setting, and mainly located at Children’s Colorado. In total, 13% of Colorado practitioners from all regions were shown to have accessed Firstline (Figure 2), with 7% of all Firstline users located outside of the Denver Metro area.

Conclusion
We disseminated a mobile application support tool to augment ASP in Colorado, with the greatest uptake in the Denver Metro area. Widespread dissemination to more rural communities in Colorado is ongoing. Future work includes assessing the impact of the application on antimicrobial utilization, clinical guideline adherence, and implementation of priority core ASP elements.

Figure 1: Run chart of monthly active users of the Children’s Colorado and Denver Health Firstline app from beginning of November 2023 through end of April 2024.

Figure 2: Proportion of Firstline users per all practitioners throughout Colorado regions. Image modified from OnTheWorldMap.com.