# A Patient and Healthcare Worker-Informed Approach to Identifying Barriers to and Strategies for Antibiotic Stewardship at the Hospital-to-Home Transition

> **NIH AHRQ R03** · JOHNS HOPKINS UNIVERSITY · 2020 · $42,207

## Abstract

Project Abstract
Antibiotic resistance is increasing worldwide, largely driven by excessive antibiotic use. Antibiotic stewardship
(AS) addresses antibiotic resistance by ensuring that only patients who require antibiotics get them, and that
patients receive the right medication at the right time at the right dose for the right duration. AS interventions
have typically focused on hospital, long-term care, and ambulatory settings in isolation. However patients also
receive antibiotics as they transition from one care setting to another. Discharge antibiotic decision-making
remains an important but under-addressed target for AS, and we require a better understanding of how to
improve this process. Optimizing AS also requires attention to post-discharge processes. Most components of
AS during the hospital-to-home transition are patient led tasks--taking the antibiotic at the right time, at the right
dose, and for the right duration—and must occur in a timely way once the patient arrives home. Medication
management (MM) refers to the ability to obtain, administer, and take medications according to a prescribed
regimen. In our model of MM during the hospital-to-home transition among older adults, we identified
healthcare worker-initiated processes and patient and caregiver-initiated processes that must be successfully
completed for patients to optimally receive prescribed treatments. However it is unclear how antibiotic MM may
fit into a general MM model. To date, no research has integrated discharge antibiotic decision-making with
patient-led antibiotic MM as a series of interrelated processes necessary for AS during the hospital-to-home
transition. We will use participatory design and multiple methods to actively engage stakeholders in describing
discharge antibiotic decision-making and antibiotic MM to identify barriers to and strategies for AS during the
hospital-to-home transition. Aim 1: To identify barriers to AS during the hospital-to-home transition in the
integrated processes of discharge antibiotic decision-making and patient-led antibiotic MM. Using the
Transition Model of MM as the underlying framework, we will interview healthcare team member stakeholders
and perform home-based contextual inquiry with semi-structured interviews of patients discharged on
antibiotics, about the intertwined processes of discharge antibiotic decision-making and patient-led antibiotic
MM. These methods will help us identify barriers to AS during the hospital-to-home transition and develop an
integrated process map for AS during the hospital-to-home transition. Aim 2: To complete a proactive risk
assessment to identify strategies to mitigate barriers to AS during the hospital-to-home transition. We
will present this data to clinicians and patients and caregivers, who will go through a Failure Modes and Effects
Analysis (FMEA) risk assessment to develop and prioritize potential strategies for addressing barriers to AS
during the hospital-to-home transition. We ...

## Key facts

- **NIH application ID:** 9961595
- **Project number:** 5R03HS026995-02
- **Recipient organization:** JOHNS HOPKINS UNIVERSITY
- **Principal Investigator:** Sara Condron Keller
- **Activity code:** R03 (R01, R21, SBIR, etc.)
- **Funding institute:** AHRQ
- **Fiscal year:** 2020
- **Award amount:** $42,207
- **Award type:** 5
- **Project period:** 2019-07-01 → 2022-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9961595

## Citation

> US National Institutes of Health, RePORTER application 9961595, A Patient and Healthcare Worker-Informed Approach to Identifying Barriers to and Strategies for Antibiotic Stewardship at the Hospital-to-Home Transition (5R03HS026995-02). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/9961595. Licensed CC0.

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