{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T14:41:27Z","timestamp":1782830487409,"version":"3.54.5"},"reference-count":21,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2022,2,10]],"date-time":"2022-02-10T00:00:00Z","timestamp":1644451200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000133","name":"Agency for Healthcare Research and Quality","doi-asserted-by":"publisher","award":["K08HS026530"],"award-info":[{"award-number":["K08HS026530"]}],"id":[{"id":"10.13039\/100000133","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Blue Cross and Blue Shield of Michigan and Blue Care Network"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,9,29]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Strategies to optimize antibiotic prescribing at discharge are not well understood.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>In fall 2019, we surveyed 39 Michigan hospitals on their antibiotic stewardship strategies. The association of reported strategies with discharge antibiotic overuse (unnecessary, excess, suboptimal fluoroquinolones) for community-acquired pneumonia (CAP) and urinary tract infection (UTI) was evaluated in 2 ways: (1) all strategies assumed equal weight and (2) strategies were weighted based on the ROAD (Reducing Overuse of Antibiotics at Discharge) Home Framework (ie, Tier 1\u2014Critical infrastructure, Tier 2\u2014Broad inpatient interventions, Tier 3\u2014Discharge-specific strategies) with Tier 3 strategies receiving the highest weight.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Between 1 July 2017 and 30 July 2019, 39 hospitals with 20\u00a0444 patients (56.5% CAP; 43.5% UTI) were included. Survey response was 100%. Hospitals reported a median (interquartile range [IQR]) 12 (9\u201314) of 34 possible stewardship strategies. On analyses of individual stewardship strategies, the Tier 3 intervention, review of antibiotics prior to discharge, was the only strategy consistently associated with lower antibiotic overuse at discharge (adjusted incident rate ratio [aIRR] 0.543, 95% confidence interval [CI]: .335\u2013.878). On multivariable analysis, weighting by ROAD Home tier predicted antibiotic overuse at discharge for both CAP and UTI. For diseases combined, having more weighted strategies was associated with lower antibiotic overuse at discharge (aIRR 0.957, 95% CI: .927\u2013.987, per weighted intervention); discharge-specific stewardship strategies were associated with a 12.4% relative decrease in antibiotic overuse days at discharge.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>The more stewardship strategies a hospital reported, the lower its antibiotic overuse at discharge. However, Tier 3, or discharge-specific strategies, appeared to have the largest effect on antibiotic prescribing at discharge.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/cid\/ciac104","type":"journal-article","created":{"date-parts":[[2022,2,9]],"date-time":"2022-02-09T12:26:56Z","timestamp":1644409616000},"page":"1063-1072","source":"Crossref","is-referenced-by-count":21,"title":["Antibiotic Stewardship Strategies and Their Association With Antibiotic Overuse After Hospital Discharge: An Analysis of the Reducing Overuse of Antibiotics at Discharge (Road) Home Framework"],"prefix":"10.1093","volume":"75","author":[{"given":"Valerie M","family":"Vaughn","sequence":"first","affiliation":[{"name":"Division of General Internal Medicine, Department of Internal Medicine, University of Utah School of Medicine , Salt Lake City, Utah , USA"},{"name":"Division of Health System Innovation & Research, Department of Population Health Science, University of Utah School of Medicine , Salt Lake City, Utah , USA"},{"name":"Division of Hospital Medicine, Department of Internal Medicine, Michigan Medicine , Ann Arbor, Michigan , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Ratz","sequence":"additional","affiliation":[{"name":"Center for Clinical Management Research, VA Ann Arbor Health System , Ann Arbor, Michigan , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M Todd","family":"Greene","sequence":"additional","affiliation":[{"name":"Division of Hospital Medicine, Department of Internal Medicine, Michigan Medicine , Ann Arbor, Michigan , USA"},{"name":"Center for Clinical Management Research, VA Ann Arbor Health System , Ann Arbor, Michigan , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scott A","family":"Flanders","sequence":"additional","affiliation":[{"name":"Division of Hospital Medicine, Department of Internal Medicine, Michigan Medicine , Ann Arbor, Michigan , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tejal N","family":"Gandhi","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Internal Medicine, Michigan Medicine , Ann Arbor, Michigan , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lindsay A","family":"Petty","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Internal Medicine, Michigan Medicine , Ann Arbor, Michigan , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sean","family":"Huls","sequence":"additional","affiliation":[{"name":"Departments of Radiology, Mayo Clinic , Rochester, Minnesota , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaomei","family":"Feng","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, University of Utah Health , Salt Lake City, Utah , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea T","family":"White","sequence":"additional","affiliation":[{"name":"Division of General Internal Medicine, Department of Internal Medicine, University of Utah School of Medicine , Salt Lake City, Utah , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adam L","family":"Hersh","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Pediatrics, University of Utah School of Medicine , Salt Lake City, Utah , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2022,2,10]]},"reference":[{"key":"2022092921001953100_CIT0001","doi-asserted-by":"crossref","first-page":"353","DOI":"10.1017\/ice.2016.276","article-title":"An evaluation of antibiotic prescribing practices upon hospital discharge.","volume":"38","author":"Scarpato","year":"2017","journal-title":"Infect Control Hosp 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