Vanderbilt University Medical Center has been approved for a $1 million funding award from the Patient-Centered Outcomes Research Institute (PCORI) to help improve antibiotic prescribing for children with acute respiratory tract infections in outpatient settings.
Antibiotic use is highest in the Southeast region of the U.S., and Tennessee consistently ranks among the top 10 highest-prescribing states, according to data from the Centers for Disease Control and Prevention. Overuse and misuse of antibiotics contributes to the spread of antibiotic resistance — a growing threat to public health.
The PCORI-funded implementation project will expand on the work of the pediatric outpatient antimicrobial stewardship program at VUMC, which has the overall goal of improving appropriate antibiotic prescribing for children seen at outpatient clinics and emergency departments affiliated with VUMC. The project is being co-led by Sophie Katz, MD, MPH, assistant professor of Pediatrics and associate medical director of the Pediatric Antimicrobial Stewardship Program, and Jenny Slayton, DNP, RN, Senior Vice President for Quality, Safety and Risk Prevention.
“Our pediatric outpatient antibiotic stewardship program was started in 2019 and is now one of the most robust in the country, thanks in large part to the buy-in and work from medical directors and front-line clinicians in our outpatient clinics and emergency departments. But there is always room for improvement,” Katz said.
The PCORI-funded implementation project seeks to reduce antibiotic prescribing for acute respiratory tract infections by 5% overall, while also fostering use of narrow-spectrum antibiotics and shorter courses of treatment and reducing excess testing for strep throat infections.
The project will take place at VUMC-affiliated outpatient pediatric primary care clinics, urgent care clinics (walk-in and pediatric after-hours clinics), retail health clinics (Vanderbilt clinics at Walgreens), emergency departments, and a Vanderbilt Health Affiliated Network community primary care practice with six care delivery sites. Across the 52 sites, the intervention will engage 376 front-line care delivery staff and will reach an estimated 103,000 patients.
The project will use evidence-based implementation strategies including distributing patient/caregiver education handouts, offering provider education through lectures and app-based quizzes, and providing audit and feedback reports with peer comparison on antibiotic use, antibiotic duration and treatment failure rates.
“Resources from this funding award will allow us to expand our pediatric outpatient antibiotic stewardship program to more sites within VUMC and the community while supporting the tool development to sustain our implementation efforts and allow for further expansion to other community sites after the funding period ends,” Slayton said.
The pediatric outpatient antibiotic stewardship project is the first implementation project funded at VUMC as part of the PCORI Health Systems Implementation Initiative (HSII). HSII aims to reduce the estimated 17-year gap between evidence publication and clinical application, according to PCORI. VUMC is one of 42 health systems that was selected to participate in HSII, co-led by Slayton and Sunil Kripalani, MD, MSc, professor of Medicine and Vice President for Health System Sciences.
“This project exemplifies PCORI’s commitment to advancing the uptake of evidence into health care delivery settings to enable patients, caregivers and clinicians to make informed health care decisions and improve care delivery and health outcomes,” said PCORI executive director Nakela Cook, MD, MPH. “We look forward to following the project’s progress and collaborating with VUMC to share its results.”
This funding award has been approved pending completion of PCORI’s business and programmatic review and issuance of a formal award contract.
