In the proposed project we will compare two different implementation strategies in a cluster-randomized intervention study, to find out which implementation strategy is the most (cost)effective to improve the quality of antibiotic use for UTIs in the hospital. Research questions:1. What is the most (cost) effective strategy, the state-of-the-art strategy or the public-reporting strategy , to improve the quality of antibiotic use in patients with complicated urinary tract infections (UTIs) in the hospital?2. Which elements of the strategies were particularly associated with successful implementation?
OBJECTIVE/RESEARCH QUESTION: To assess the (cost)-effectiveness of two strategies to improve the quality of antibiotic use in patients with urinary tract infections (UTIs). STUDY DESIGN/POPULATION/INTERVENTION: A cluster-randomized controlled trial, including consecutive patients from two departments (Internal Medicine and Urology) in 18 participating hospitals. After a baseline measurement in 50 patients from each department, using clinically validated indicators, hospitals will be randomized between two implementation strategies. In a post-intervention measurement, quality of antibiotic use will be assessed again for these departments. IMPLEMENTATION STRATEGIES: A theory-based and effective, but labour-intensive strategy (the state-of-the-art strategy) is compared to a currently popular strategy of providing public comparative information on quality of antibiotic care (the public reporting strategy).OUTCOME MEASURES: Clinically validated indicators extracted from a recent national guideline for the treatment of complicated UTIs. SAMPLE SIZE/DATA ANALYSIS: To demonstrate a difference of 15% in indicator adherence between the two strategies, with baseline-and postintervention measurements, alpha=0.05, two-sided testing, power=0.80 and inter correlation coefficient (icc)=0,10, we need a total number of 2 (strategies) x 2 (pre/post-measurements) x 18 clusters with 50 patients/cluster= 3,400 patients with a UTI. Data will be extracted from medical charts of patients. Multilevel regression analyses will be performed to compare the effectiveness of both strategies.ECONOMIC EVALUATION: The costs of the two different implementation strategies will be evaluated in relation to differences in effectiveness between the two strategies in improvement of quality indicators.TIME SCHEDULE: Month 1-10: Patient inclusion and baseline measurements. Month 11-23: Qualitative analysis and implementation activities. Month 24-30: Post-intervention measurements and preparing data-analysis. Month 31-36: Data analysis and reporting. |
