Precision Antimicrobial STewardship for Clostridioides DIfficile Prevention

Study Overview
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Brief Summary
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To decrease CDI incidence by implementing an electronic health record-integrated CDI-risk classification tool for Clostridioides difficile infection (CDI) to focus a bundle of antimicrobial stewardship (AMS) CDI prevention recommendations on high-risk patients.

Detailed Description
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This study aims to use a pre/post implementation design to evaluate the use of a novel risk classification tool to improve existing methods of identifying patients eligible for routine antimicrobial stewardship (AMS) care processes targeting reduction of Clostridioides difficile infection (CDI). Antimicrobial stewardship is an established, evidence-based quality improvement program that is required by The Joint Commission and a condition of participation by the Centers for Medicare and Medicaid. AMS processes of care are evidence based, supported by published research demonstrating outcomes benefits, are recommended by national guidelines and are not investigational. Treatment decisions remain at the discretion of clinicians and patients

Official Title
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Precision Antimicrobial STewardship for Clostridioides DIfficile Prevention

Conditions
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CDI

Intervention / Treatment
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* Other: CDI-risk Classification Tool


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: adult acute care patients identified as high-CDI risk by the CDI risk classification tool. This sub-group represents approximately 6% of all acute care admissions Exclusion Criteria: Behavioral health units Inpatient rehabilitation units Labor and Delivery units Same day surgery and observation units

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Pre-Implementation<br> | |
| Post-Implementation<br> | Other: CDI-risk Classification Tool<br>* This tool will focus a bundle of antimicrobial stewardship (AMS) CDI prevention recommendations on high-risk patients.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Per-Admission Rate | per-admission rate of hospital-associated CDI, defined as: positive toxin B by enzyme-linked immunoassay or polymerase chain reaction test at least 72 hours after admission | 30 days after discharge | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Total Antibiotic Usage |  | through study completion, an average of 1 year | 
| High-Risk Antibiotic Usage |  | through study completion, an average of 1 year | 
| Proton Pump Inhibitor Therapy Administered |  | through study completion, an average of 1 year | 
| Total Variable Cost per Admission |  | through study completion, an average of 1 year | 
| Hospital Length of Stay |  | through study completion, an average of 1 year |