Impact of a Pathway for Chronic Obstructive Pulmonary Disease Exacerbations (COPDE) on Antimicrobial Prescribing and Readmissions
Bibliographic record
Abstract
Background. Chronic obstructive pulmonary disease exacerbations (COPDE) are frequently overtreated with antibiotics. In April 2014, a clinical pathway for COPDE was released as part of our Antimicrobial Stewardship Program (ASP) at The Ottawa Hospital (TOH). TOH is an 1100-bed, tertiary-care institution in Ottawa, Canada, with acute care beds distributed over two geographically distinct campuses. Objectives. To determine whether (1) the clinical pathway (intervention) resulted in improved antibiotic prescribing or (2) patients treated as per the pathway had different readmission rates for pulmonary infections or COPDE compared to patients who were not. Methods. A retrospective chart review of patients admitted with a COPDE between September 2013 and December 2013 was performed, and compared to COPDE admissions between September 2014 to December 2014 for appropriateness of antibiotic use, agent and duration as defined in the COPDE pathway. Readmission rates for patients treated or not treated according to the pathway were also assessed. Charts were excluded if there was concomitant pneumonia, a second admission under the same service within the same 4-month time period, or if the patient's condition was not covered by the pathway (e.g. cystic fibrosis). Services selected were internal medicine, family medicine, respirology and the intensive care unit. Results. 45 pre-intervention charts and 45 post-intervention charts were reviewed. Overall, only the choice of agent improved after the implementation of the clinical pathway. Due to a lack of resources, stewardship rounds were not performed at Campus B from mid-October to December 2014, which may explain the difference in findings between campuses. Overall, regardless of the time period, 7 of 53 (13%) patients treated according to the pathway were readmitted within one month of discharge for a COPDE or a pulmonary infection compared to 6 of 37 (16%) who were not treated according to the pathway. Conclusion. This retrospective chart review suggests that a clinical pathway, in conjunction with active promotion by the ASP, helps improve antibiotic management of COPDE. Treating according to the pathway did not result in an increase in readmission rate. Disclosures. All authors: No reported disclosures.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.017 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".