{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T21:23:25Z","timestamp":1790371405052,"version":"4.1.0"},"reference-count":45,"publisher":"Cambridge University Press (CUP)","issue":"1","license":[{"start":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T00:00:00Z","timestamp":1780272000000},"content-version":"unspecified","delay-in-days":151,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["ASHE"],"published-print":{"date-parts":[[2026]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec id=\"S2732494X26104185_as1\">\n                    <jats:title>Objective:<\/jats:title>\n                    <jats:p>\n                      The aim was to describe the development and implementation of Firstline (\n                      <jats:uri xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"https:\/\/www.Firstline.org\">www.Firstline.org<\/jats:uri>\n                      ), a mobile antimicrobial stewardship (ASP) application (app) created to address barriers to robust ASP in Colorado hospitals.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S2732494X26104185_as2\">\n                    <jats:title>Design:<\/jats:title>\n                    <jats:p>A mixed-methods pragmatic implementation study using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework was conducted from October 2023\u2013December 2025.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S2732494X26104185_as3\">\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>ASP teams at Children\u2019s Hospital Colorado and Denver Health partnered with Firstline to develop the app using locally curated content. The app launched in October 2023 with a multifaceted dissemination campaign. Reach was assessed using geocoded user data. Effectiveness and adoption were evaluated using cross-sectional surveys at two time points. Implementation was characterized by analyzing utilization patterns. Maintenance was assessed by tracking monthly active users over two years.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S2732494X26104185_as4\">\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Within the first year, 4,409 unique Colorado users downloaded the app, representing 15% of state clinicians (19% in Denver Metro; 5\u201317% in rural regions). Survey respondents (n = 215) reported high satisfaction: 63.9% and 72.9% found the app very easy to use, 71.3% and 83.2% reported enhanced antibiotic selection knowledge, and 100% advocated for ongoing support. Among respondents, 10% reported their facilities had formally adopted Firstline guidelines. The most frequently accessed content included common, high-impact infections. Monthly active users remained stable (average 871) over two years.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S2732494X26104185_as5\">\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>We demonstrated use of Firstline across Colorado, with increasing engagement in rural areas. High user satisfaction, sustained engagement, and emerging institutional adoption suggest this \u201cstewardship in your pocket\u201d model offers a unique, scalable approach to extending ASP support beyond academic medical centers.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1017\/ash.2026.10418","type":"journal-article","created":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T07:24:09Z","timestamp":1780298649000},"source":"Crossref","is-referenced-by-count":1,"title":["Stewardship in your pocket: launching Colorado\u2019s free antimicrobial mobile application"],"prefix":"10.1017","volume":"6","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-4279-0393","authenticated-orcid":false,"given":"Joana","family":"Dimo","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/02hh7en24","id-type":"ROR","asserted-by":"publisher"}],"name":"University of Colorado School of Medicine: University of Colorado Anschutz Medic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9543-0158","authenticated-orcid":false,"given":"Sarah K.","family":"Parker","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/02hh7en24","id-type":"ROR","asserted-by":"publisher"}],"name":"University of Colorado School of Medicine: University of Colorado Anschutz Medic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew J.","family":"Weber","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/02hh7en24","id-type":"ROR","asserted-by":"publisher"}],"name":"University of Colorado School of Medicine: University of Colorado Anschutz Medic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew A.","family":"Miller","sequence":"additional","affiliation":[{"name":"University of Colorado School of Medicine: University of Colorado Anschutz Medic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6152-5690","authenticated-orcid":false,"given":"Kira E.","family":"Frappa","sequence":"additional","affiliation":[{"name":"University of Colorado School of Medicine: University of Colorado Anschutz Medic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-8410-197X","authenticated-orcid":false,"given":"Christine E.","family":"MacBrayne","sequence":"additional","affiliation":[{"name":"University of Colorado School of Medicine: University of Colorado Anschutz Medic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-9375-680X","authenticated-orcid":false,"given":"Katherine C.","family":"Shihadeh","sequence":"additional","affiliation":[{"name":"Denver Health Medical Center: Denver Health Main Campus"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1735-5468","authenticated-orcid":false,"given":"Margeret M.","family":"Cooper","sequence":"additional","affiliation":[{"name":"Denver Health Medical Center: Denver Health Main Campus"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1608-1290","authenticated-orcid":false,"given":"Lauren R.","family":"Biehle","sequence":"additional","affiliation":[{"name":"Colorado Department of Public Health and Environment"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1029-7085","authenticated-orcid":false,"given":"Timothy C.","family":"Jenkins","sequence":"additional","affiliation":[{"name":"Denver Health Medical Center: Denver Health Main Campus"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4248-2637","authenticated-orcid":false,"given":"Michael J.","family":"Bozzella","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/02hh7en24","id-type":"ROR","asserted-by":"publisher"}],"name":"University of Colorado School of Medicine: University of Colorado Anschutz Medic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9251-3222","authenticated-orcid":false,"given":"Leigh Anne","family":"Bakel","sequence":"additional","affiliation":[{"name":"University of Colorado School of Medicine: University of Colorado Anschutz Medic"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2026,6,1]]},"reference":[{"key":"S2732494X26104185_ref27","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/cix407"},{"key":"S2732494X26104185_ref34","doi-asserted-by":"publisher","DOI":"10.1016\/j.cmi.2025.02.026"},{"key":"S2732494X26104185_ref35","unstructured":"35. 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