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NORC is working with Johns Hopkins Medicine (JHM) to implement and evaluate the Comprehensive Unit-based Safety Program (CUSP) for Antibiotic Stewardship program, a multi-year effort focused on developing and enhancing antibiotic stewardship programs.

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Although antibiotics can be vital for improving the outcomes of critically-ill patients, their use is not always benign and they can cause harm, including certain infections and the development of antibiotic resistance on both a patient and a population level. NORC is working with Johns Hopkins Medicine (JHM) to implement and evaluate the Comprehensive Unit-based Safety Program (CUSP) for Antibiotic Stewardship program, a multi-year effort focused on developing and enhancing antibiotic stewardship programs (ASPs) across care settings throughout the United States—as well as equipping frontline providers with the necessary knowledge and skills to enhance their antibiotic prescribing practices.

The overarching goals of the Comprehensive Unit-based Safety Program (CUSP) for Antibiotic Stewardship are: 1) to identify the best practices in delivery of antibiotic stewardship (AS) in the acute care, long term care (LTC), and ambulatory care settings, 2) to determine how to best adapt the CUSP model to enhance AS efforts in these health care settings, and 3) to implement a bundle of technical and adaptive interventions designed to increase the uptake of AS across multiple institutions and practices. During Cohort 1, NORC and Johns Hopkins Medicine recruited three integrated delivery systems to 1) assess the adoption of CUSP for AS; 2) measure the effectiveness of the CUSP for AS interventions in the participating IDSs; and 3) evaluate the characteristics of teams and senior leaders that are associated with successful implementation and improvements in outcomes. During Cohorts 2, 3, and 4, the program team scaled the intervention to over 400 hospitals, 450 long-term care facilities, and 450 ambulatory care sites. NORC is conducting a mixed-method evaluation of AS adoption across these three different care settings to gauge impact on provider prescribing behaviors.

The program is supported by a Technical Expert Panel (TEP) consisting of subject matter experts representing leaders in ASPs across acute care, long-term care, and ambulatory care settings, leaders of patients/patient advocacy groups, experts with experience conducting largescale interventional studies involving adaptive changes, executives from integrated healthcare delivery systems, and ex-officio members from government agencies. Three quality improvement organizations are working to support implementation of the program. NORC hosts all the educational webinars and office hours to facilitate peer-to-peer sharing. NORC is also collecting periodic data from the participating sites throughout the implementation phase of the program, using a secure data submission portal, and is conducting a comprehensive, mixed methods evaluation to assess adoption of the program; measure effectiveness of the CUSP interventions in participating sites; and evaluate characteristics of teams and senior leaders associated with successful implementation and improvements in outcomes.

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