{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T01:51:17Z","timestamp":1792029077393,"version":"4.4.0"},"reference-count":31,"publisher":"American Medical Association (AMA)","issue":"23","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA"],"published-print":{"date-parts":[[2024,6,18]]},"abstract":"<jats:sec><jats:title>Importance<\/jats:title><jats:p>Pneumonia is the most common infection requiring hospitalization and is a major reason for overuse of extended-spectrum antibiotics. Despite low risk of multidrug-resistant organism (MDRO) infection, clinical uncertainty often drives initial antibiotic selection. Strategies to limit empiric antibiotic overuse for patients with pneumonia are needed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>To evaluate whether computerized provider order entry (CPOE) prompts providing patient- and pathogen-specific MDRO infection risk estimates could reduce empiric extended-spectrum antibiotics for non\u2013critically ill patients admitted with pneumonia.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design, Setting, and Participants<\/jats:title><jats:p>Cluster-randomized trial in 59 US community hospitals comparing the effect of a CPOE stewardship bundle (education, feedback, and real-time MDRO risk-based CPOE prompts; n\u2009=\u200929 hospitals) vs routine stewardship (n\u2009=\u200930 hospitals) on antibiotic selection during the first 3 hospital days (empiric period) in non\u2013critically ill adults (\u226518 years) hospitalized with pneumonia. There was an 18-month baseline period from April 1, 2017, to September 30, 2018, and a 15-month intervention period from April 1, 2019, to June 30, 2020.<\/jats:p><\/jats:sec><jats:sec><jats:title>Intervention<\/jats:title><jats:p>CPOE prompts recommending standard-spectrum antibiotics in patients ordered to receive extended-spectrum antibiotics during the empiric period who have low estimated absolute risk (&amp;amp;lt;10%) of MDRO pneumonia, coupled with feedback and education.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main Outcomes and Measures<\/jats:title><jats:p>The primary outcome was empiric (first 3 days of hospitalization) extended-spectrum antibiotic days of therapy. Secondary outcomes included empiric vancomycin and antipseudomonal days of therapy and safety outcomes included days to intensive care unit (ICU) transfer and hospital length of stay. Outcomes compared differences between baseline and intervention periods across strategies.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among 59 hospitals with 96\u202f451 (51\u202f671 in the baseline period and 44\u202f780 in the intervention period) adult patients admitted with pneumonia, the mean (SD) age of patients was 68.1 (17.0) years, 48.1% were men, and the median (IQR) Elixhauser comorbidity count was 4 (2-6). Compared with routine stewardship, the group using CPOE prompts had a 28.4% reduction in empiric extended-spectrum days of therapy (rate ratio, 0.72 [95% CI, 0.66-0.78]; <jats:italic>P<\/jats:italic>\u2009&amp;amp;lt;\u2009.001). Safety outcomes of mean days to ICU transfer (6.5 vs 7.1 days) and hospital length of stay (6.8 vs 7.1 days) did not differ significantly between the routine and CPOE intervention groups.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions and Relevance<\/jats:title><jats:p>Empiric extended-spectrum antibiotic use was significantly lower among adults admitted with pneumonia to non-ICU settings in hospitals using education, feedback, and CPOE prompts recommending standard-spectrum antibiotics for patients at low risk of MDRO infection, compared with routine stewardship practices. Hospital length of stay and days to ICU transfer were unchanged.<\/jats:p><\/jats:sec><jats:sec><jats:title>Trial Registration<\/jats:title><jats:p>ClinicalTrials.gov Identifier: <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/clinicaltrials.gov\/study\/NCT03697070\">NCT03697070<\/jats:ext-link><\/jats:p><\/jats:sec>","DOI":"10.1001\/jama.2024.6248","type":"journal-article","created":{"date-parts":[[2024,4,19]],"date-time":"2024-04-19T14:34:33Z","timestamp":1713537273000},"page":"2007","source":"Crossref","is-referenced-by-count":51,"title":["Stewardship Prompts to Improve Antibiotic Selection for Pneumonia"],"prefix":"10.1001","volume":"331","author":[{"given":"Shruti K.","family":"Gohil","sequence":"first","affiliation":[{"name":"Division of Infectious Diseases, University of California, Irvine School of Medicine, Irvine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edward","family":"Septimus","sequence":"additional","affiliation":[{"name":"Department of Population Medicine, Harvard Pilgrim Healthcare Institute, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ken","family":"Kleinman","sequence":"additional","affiliation":[{"name":"Biostatistics and Epidemiology, University of Massachusetts, Amherst"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neha","family":"Varma","sequence":"additional","affiliation":[{"name":"Department of Population Medicine, Harvard Pilgrim Healthcare Institute, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Taliser R.","family":"Avery","sequence":"additional","affiliation":[{"name":"Department of Population Medicine, Harvard Pilgrim Healthcare Institute, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lauren","family":"Heim","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, University of California, Irvine School of Medicine, Irvine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Risa","family":"Rahm","sequence":"additional","affiliation":[{"name":"HCA Healthcare, Nashville, Tennessee"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William S.","family":"Cooper","sequence":"additional","affiliation":[{"name":"HCA Healthcare, Nashville, Tennessee"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mandelin","family":"Cooper","sequence":"additional","affiliation":[{"name":"HCA Healthcare, Nashville, Tennessee"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura E.","family":"McLean","sequence":"additional","affiliation":[{"name":"HCA Healthcare, Nashville, Tennessee"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naoise G.","family":"Nickolay","sequence":"additional","affiliation":[{"name":"HCA Healthcare, Nashville, Tennessee"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert A.","family":"Weinstein","sequence":"additional","affiliation":[{"name":"Rush University Medical Center, Cook County Health, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L. Hayley","family":"Burgess","sequence":"additional","affiliation":[{"name":"HCA Healthcare, Nashville, Tennessee"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Micaela H.","family":"Coady","sequence":"additional","affiliation":[{"name":"Department of Population Medicine, Harvard Pilgrim Healthcare Institute, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edward","family":"Rosen","sequence":"additional","affiliation":[{"name":"Department of Population Medicine, Harvard Pilgrim Healthcare Institute, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Selsebil","family":"Sljivo","sequence":"additional","affiliation":[{"name":"Department of Population Medicine, Harvard Pilgrim Healthcare Institute, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenneth E.","family":"Sands","sequence":"additional","affiliation":[{"name":"Department of Population Medicine, Harvard Pilgrim Healthcare Institute, Harvard Medical School, Boston, Massachusetts"},{"name":"HCA Healthcare, Nashville, Tennessee"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julia","family":"Moody","sequence":"additional","affiliation":[{"name":"HCA Healthcare, Nashville, Tennessee"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Justin","family":"Vigeant","sequence":"additional","affiliation":[{"name":"Department of Population Medicine, Harvard Pilgrim Healthcare Institute, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Syma","family":"Rashid","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, University of California, Irvine School of Medicine, Irvine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebecca F.","family":"Gilbert","sequence":"additional","affiliation":[{"name":"Department of Population Medicine, Harvard Pilgrim Healthcare Institute, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kim N.","family":"Smith","sequence":"additional","affiliation":[{"name":"HCA Healthcare, Nashville, Tennessee"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brandon","family":"Carver","sequence":"additional","affiliation":[{"name":"HCA Healthcare, Nashville, Tennessee"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Russell E.","family":"Poland","sequence":"additional","affiliation":[{"name":"Department of Population Medicine, Harvard Pilgrim Healthcare Institute, Harvard Medical School, Boston, Massachusetts"},{"name":"HCA Healthcare, Nashville, Tennessee"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason","family":"Hickok","sequence":"additional","affiliation":[{"name":"HCA Healthcare, Nashville, Tennessee"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S. G.","family":"Sturdevant","sequence":"additional","affiliation":[{"name":"National Institutes of Health, Bethesda, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael S.","family":"Calderwood","sequence":"additional","affiliation":[{"name":"Section of Infectious Disease and International Health, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anastasiia","family":"Weiland","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, University of California, Irvine School of Medicine, Irvine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David W.","family":"Kubiak","sequence":"additional","affiliation":[{"name":"Brigham and Women\u2019s Hospital, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sujan","family":"Reddy","sequence":"additional","affiliation":[{"name":"Centers for Disease Control and Prevention, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melinda M.","family":"Neuhauser","sequence":"additional","affiliation":[{"name":"Centers for Disease Control and Prevention, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arjun","family":"Srinivasan","sequence":"additional","affiliation":[{"name":"Centers for Disease Control and Prevention, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John A.","family":"Jernigan","sequence":"additional","affiliation":[{"name":"Centers for Disease Control and Prevention, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary K.","family":"Hayden","sequence":"additional","affiliation":[{"name":"Rush University Medical Center, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abinav","family":"Gowda","sequence":"additional","affiliation":[{"name":"Department of Population Medicine, Harvard Pilgrim Healthcare Institute, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katyuska","family":"Eibensteiner","sequence":"additional","affiliation":[{"name":"Department of Population Medicine, Harvard Pilgrim Healthcare Institute, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Wolf","sequence":"additional","affiliation":[{"name":"Department of Population Medicine, Harvard Pilgrim Healthcare Institute, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan B.","family":"Perlin","sequence":"additional","affiliation":[{"name":"HCA Healthcare, Nashville, Tennessee"},{"name":"Now with The Joint Commission, Oakbrook Terrace, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Platt","sequence":"additional","affiliation":[{"name":"Department of Population Medicine, Harvard Pilgrim Healthcare Institute, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan S.","family":"Huang","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, University of California, Irvine School of Medicine, Irvine"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","reference":[{"issue":"2","key":"joi240049r1","doi-asserted-by":"publisher","first-page":"255","DOI":"10.1016\/j.chest.2019.04.013","article-title":"Infectious disease hospitalizations: United States, 2001 to 2014.","volume":"156","author":"Kennedy","year":"2019","journal-title":"Chest"},{"issue":"10","key":"joi240049r2","doi-asserted-by":"publisher","first-page":"1784","DOI":"10.1093\/cid\/ciaa373","article-title":"Antimicrobial use in US hospitals: comparison of results from emerging infections program prevalence surveys, 2015 and 2011.","volume":"72","author":"Magill","year":"2021","journal-title":"Clin Infect Dis"},{"issue":"3","key":"joi240049r4","doi-asserted-by":"publisher","first-page":"153","DOI":"10.7326\/M18-3640","article-title":"Excess antibiotic treatment duration and adverse events in patients hospitalized with pneumonia: a multihospital cohort study.","volume":"171","author":"Vaughn","year":"2019","journal-title":"Ann Intern Med"},{"issue":"4","key":"joi240049r5","doi-asserted-by":"publisher","first-page":"485","DOI":"10.1001\/jamainternmed.2019.7251","article-title":"Overuse of broad-spectrum antibiotics for pneumonia.","volume":"180","author":"Klompas","year":"2020","journal-title":"JAMA Intern Med"},{"issue":"8","key":"joi240049r6","doi-asserted-by":"publisher","first-page":"1314","DOI":"10.1093\/cid\/ciaa212","article-title":"De-escalation of empiric antibiotics following negative cultures in hospitalized patients with pneumonia: rates and outcomes.","volume":"72","author":"Deshpande","year":"2021","journal-title":"Clin Infect Dis"},{"issue":"11","key":"joi240049r8","doi-asserted-by":"publisher","first-page":"1639","DOI":"10.1001\/jamainternmed.2016.5651","article-title":"Estimating National Trends in Inpatient Antibiotic Use Among US Hospitals From 2006 to 2012.","volume":"176","author":"Baggs","year":"2016","journal-title":"JAMA Intern Med"},{"issue":"9","key":"joi240049r9","doi-asserted-by":"publisher","first-page":"1308","DOI":"10.1001\/jamainternmed.2017.1938","article-title":"Association of adverse events with antibiotic use in hospitalized patients.","volume":"177","author":"Tamma","year":"2017","journal-title":"JAMA Intern Med"},{"issue":"7","key":"joi240049r10","doi-asserted-by":"publisher","first-page":"e45","DOI":"10.1164\/rccm.201908-1581ST","article-title":"Diagnosis and treatment of adults with community-acquired pneumonia: an official clinical practice guideline of the American Thoracic Society and Infectious Diseases Society of America.","volume":"200","author":"Metlay","year":"2019","journal-title":"Am J Respir Crit Care Med"},{"issue":"4","key":"joi240049r11","doi-asserted-by":"publisher","first-page":"1219","DOI":"10.1093\/jac\/dku479","article-title":"Safety and clinical outcomes of carbapenem de-escalation as part of an antimicrobial stewardship programme in an ESBL-endemic setting.","volume":"70","author":"Lew","year":"2015","journal-title":"J Antimicrob Chemother"},{"issue":"4","key":"joi240049r12","doi-asserted-by":"publisher","first-page":"552","DOI":"10.1001\/jamainternmed.2019.7495","article-title":"Empirical anti-MRSA vs standard antibiotic therapy and risk of 30-day mortality in patients hospitalized for pneumonia.","volume":"180","author":"Jones","year":"2020","journal-title":"JAMA Intern Med"},{"issue":"4","key":"joi240049r13","doi-asserted-by":"publisher","first-page":"428","DOI":"10.1016\/j.jhin.2018.08.007","article-title":"Balancing the risks to individual and society: a systematic review and synthesis of qualitative research on antibiotic prescribing behaviour in hospitals.","volume":"101","author":"Krockow","year":"2019","journal-title":"J Hosp Infect"},{"issue":"2","key":"joi240049r14","doi-asserted-by":"publisher","first-page":"167","DOI":"10.1097\/QCO.0000000000000254","article-title":"Empiric antibiotic selection and risk prediction of drug-resistant pathogens in community-onset pneumonia.","volume":"29","author":"Webb","year":"2016","journal-title":"Curr Opin Infect Dis"},{"issue":"3","key":"joi240049r15","doi-asserted-by":"publisher","first-page":"300","DOI":"10.1093\/cid\/ciw300","article-title":"Staphylococcus aureus community-acquired Pneumonia: prevalence, clinical characteristics, and outcomes.","volume":"63","author":"Self","year":"2016","journal-title":"Clin Infect Dis"},{"key":"joi240049r16","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2024.6259","article-title":"Stewardship prompts to improve antibiotic selection for urinary tract infection: the INSPIRE randomized clinical trial.","author":"Gohil","year":"2024","journal-title":"JAMA"},{"issue":"1","key":"joi240049r17","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1093\/cid\/ciy024","article-title":"The clinical utility of methicillin-resistant Staphylococcus aureus (MRSA) nasal screening to rule out MRSA pneumonia: a diagnostic meta-analysis with antimicrobial stewardship implications.","volume":"67","author":"Parente","year":"2018","journal-title":"Clin Infect Dis"},{"key":"joi240049r19","doi-asserted-by":"publisher","DOI":"10.1016\/j.conctc.2021.100746","article-title":"Matching in cluster randomized trials using the Goldilocks Approach.","volume":"22","author":"Sturdevant","year":"2021","journal-title":"Contemp Clin Trials Commun"},{"issue":"10","key":"joi240049r20","doi-asserted-by":"publisher","first-page":"1222","DOI":"10.1017\/ice.2020.215","article-title":"Assessment of race and sex as risk factors for colonization with multidrug-resistant organisms in six nursing homes.","volume":"41","author":"Gontjes","year":"2020","journal-title":"Infect Control Hosp Epidemiol"},{"issue":"2","key":"joi240049r21","doi-asserted-by":"publisher","first-page":"187","DOI":"10.1038\/s41591-020-01201-9","article-title":"Antibiotic resistance: a call to action to prevent the next epidemic of inequality.","volume":"27","author":"Nadimpalli","year":"2021","journal-title":"Nat Med"},{"issue":"9","key":"joi240049r22","doi-asserted-by":"publisher","first-page":"1009","DOI":"10.1097\/MLR.0b013e3181a80fdc","article-title":"Racial and ethnic disparities in pneumonia treatment and mortality.","volume":"47","author":"Hausmann","year":"2009","journal-title":"Med Care"},{"issue":"1","key":"joi240049r23","doi-asserted-by":"publisher","first-page":"8","DOI":"10.1097\/00005650-199801000-00004","article-title":"Comorbidity measures for use with administrative data.","volume":"36","author":"Elixhauser","year":"1998","journal-title":"Med Care"},{"issue":"5","key":"joi240049r24","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2023.14185","article-title":"Incidence and outcomes of non-ventilator-associated hospital-acquired pneumonia in 284 US hospitals using electronic surveillance criteria.","volume":"6","author":"Jones","year":"2023","journal-title":"JAMA Netw Open"},{"key":"joi240049r25","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2024.0077","article-title":"Inappropriate diagnosis of pneumonia among hospitalized adults.","author":"Gupta","year":"2024","journal-title":"JAMA Intern Med"},{"issue":"3","key":"joi240049r26","doi-asserted-by":"publisher","first-page":"181","DOI":"10.1002\/jhm.v11.3","article-title":"Impact of antibiotic choices made in the emergency department on appropriateness of antibiotic treatment of urinary tract infections in hospitalized patients.","volume":"11","author":"Kiyatkin","year":"2016","journal-title":"J Hosp Med"},{"key":"joi240049r27","doi-asserted-by":"publisher","first-page":"s354","DOI":"10.1093\/ofid\/ofz360.870","article-title":"Do antibiotic choices made in the ED influence inpatient therapy?","volume":"6","author":"Jones","year":"2019","journal-title":"Open Forum Infect Dis"},{"issue":"8","key":"joi240049r28","doi-asserted-by":"publisher","first-page":"1131","DOI":"10.1086\/588450","article-title":"At the threshold: defining clinically meaningful resistance thresholds for antibiotic choice in community-acquired pneumonia.","volume":"46","author":"Daneman","year":"2008","journal-title":"Clin Infect Dis"},{"issue":"1","key":"joi240049r29","doi-asserted-by":"publisher","first-page":"613","DOI":"10.1007\/s40121-021-00403-z","article-title":"The kinetics of an antibiotic stewardship intervention: a quasi-experimental study.","volume":"10","author":"Shafat","year":"2021","journal-title":"Infect Dis Ther"},{"issue":"1","key":"joi240049r30","doi-asserted-by":"publisher","first-page":"134","DOI":"10.1186\/s13690-021-00624-1","article-title":"Understanding the complexities of antibiotic prescribing behaviour in acute hospitals: a systematic review and meta-ethnography.","volume":"79","author":"Wojcik","year":"2021","journal-title":"Arch Public Health"},{"issue":"8","key":"joi240049r31","doi-asserted-by":"publisher","first-page":"847","DOI":"10.1097\/MLR.0b013e318178eabd","article-title":"Interventions to reduce unnecessary antibiotic prescribing: a systematic review and quantitative analysis.","volume":"46","author":"Ranji","year":"2008","journal-title":"Med Care"},{"key":"joi240049r18","author":"Mahalanobis","year":"1936"},{"key":"joi240049r3","unstructured":"Centers for Disease Control and Prevention. Antibiotic resistance threats in the United States, 2019. Accessed September 16, 2023. https:\/\/www.cdc.gov\/drugresistance\/pdf\/threats-report\/2019-ar-threats-report-508.pdf"},{"key":"joi240049r7","unstructured":"Core Elements of Hospital Antibiotic Stewardship Programs. Centers for Disease Control and Prevention. Accessed September 16, 2023. https:\/\/www.cdc.gov\/antibiotic-use\/core-elements\/hospital.html"}],"container-title":["JAMA"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jama\/articlepdf\/2817976\/jama_gohil_2024_oi_240049_1717690928.61621.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,6,18]],"date-time":"2024-06-18T15:48:23Z","timestamp":1718725703000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jama\/fullarticle\/2817976"}},"subtitle":["The INSPIRE Randomized Clinical Trial"],"short-title":[],"issued":{"date-parts":[[2024,6,18]]},"references-count":31,"journal-issue":{"issue":"23","published-print":{"date-parts":[[2024,6,18]]}},"URL":"https:\/\/doi.org\/10.1001\/jama.2024.6248","relation":{},"ISSN":["0098-7484"],"issn-type":[{"value":"0098-7484","type":"print"}],"subject":[],"published":{"date-parts":[[2024,6,18]]}}}