PROJECT SUMMARY Antibiotic overuse in hospitalized patients is common and leads to adverse events, such as increased antibiotic resistance and Clostridioides difficile infection. Antibiotics prescribed at hospital discharge account for up to half of antibiotic use related to hospitalization and are often unnecessary. For infections such as urinary tract infection and pneumonia, the majority of antibiotics prescribed at discharge are written by hospitalists. Thus, engaging this group of providers is needed to improve antibiotic use at discharge. The long-term goal of this career development award is to promote the candidate's development into an independently funded physician-scientist with expertise in improving appropriate use of medical therapies. Using antibiotics prescribed at hospital discharge as a model for this work, this project aims to: 1) assess the drivers of antibiotic overuse at hospital discharge, 2) examine barriers to and facilitators of appropriate antibiotic treatment at discharge, and 3) develop and pilot a behavioral intervention to improve appropriate use of antibiotics at hospital discharge. Successful completion of this work will substantially impact patient care and ensure the candidate's future success through acquisition of critical skills and content expertise in reducing medical overuse at discharge. Finally, this work fits with AHRQ's research priority area #1 of conducting research to improve health care patient safety and with AHRQ's interest in combating healthcare-associated infections and antibiotic resistance. The candidate will pursue a mentored research plan that promotes development of expertise in: 1) multilevel methods to evaluate the relative contributions of patient and organization-level effects on provider decisions such as antibiotic prescribing; 2) qualitative research methods to better understand prescribing practices; and 3) designing and evaluating provider-facing behavioral interventions to influence prescribing practices. The career development plan consists of a multidisciplinary team of experienced mentors and advisors who will oversee a range of formal coursework and practical experiences to ensure the candidates' success. Exceptional resources and a mentoring team with proven success in developing junior physician-scientists make the University of Michigan an ideal environment for this proposal.

PROJECT NARRATIVE Antibiotic overuse at hospital discharge is an overlooked contributor to patient harm, as it leads to adverse events, such as Clostridioides difficile infection and antibiotic resistance. This project will generate new knowledge on predictors, barriers, and solutions to antibiotic overuse at hospital discharge, thus improving the care of hospitalized patients.