PROJECT SUMMARY/ABSTRACT The Reducing Overuse of Antibiotics at Discharge (ROAD) Home trial is a 40-hospital cluster randomized trial to evaluate the effectiveness and understand factors influencing implementation of the ROAD Home intervention. Antibiotic overuse at hospital discharge is common, costly, and harmful. While evidence-based antibiotic stewardship strategies exist to improve prescribing, they are not reaching patients as they transition across care settings. Hospital discharge represents one care transition in critical need of effective stewardship interventions that can be used across a variety of contexts. In the US, antibiotics prescribed at discharge account for half of antibiotic use—and up to 90% of days of overuse—related to hospitalization. Discharge- specific stewardship strategies (e.g., audit and feedback at discharge) are effective at optimizing prescribing; however, they are resource-intensive and often infeasible to implement across hospitals with variable resources. Thus, there is a critical need for interventions to improve discharge prescribing that are tailored to local context, feasible, and effective for diverse hospitals. To address this need, the ROAD Home study team developed the ROAD Home Framework which specifies evidence-based stewardship strategies to improve discharge antibiotic prescribing. The ROAD Home Framework is the foundation for the ROAD Home Intervention, a participatory intervention that supports hospitals in implementing evidence-based stewardship strategies to improve discharge antibiotic use. The ROAD Home Intervention includes three components: 1) discharge stewardship needs assessment, 2) facilitated selection of strategies using the ROAD Home Framework, and 3) an implementation blueprint. The overarching goal of this study is to evaluate the effectiveness and understand the implementation context of the ROAD Home Intervention. The central hypothesis is that hospitals participating in the ROAD Home Intervention will have fewer days of antibiotic overuse at discharge compared to usual care hospitals. The proposed trial will leverage the researcher’s extensive prior success conducting antibiotic stewardship research with the Michigan Hospital Medicine Safety Consortium (HMS), a group of 69 hospitals working to improve care for hospitalized patients. The specific aims are: (1) within HMS, conduct a 40-hospital parallel cluster randomized trial to test the effectiveness of the ROAD Home Intervention on days of antibiotic overuse at discharge in hospitalized adults with CAP and UTI, (2) conduct a mixed-methods concurrent process evaluation to identify contextual factors influencing implementation of the ROAD Home Intervention, and (3) create and refine a ROAD Home discharge stewardship toolkit. There is an urgent need to improve antibiotic prescribing at hospital discharge. Building on prior AHRQ-funded work, this study will rigorously evaluate the innovative ROAD Home Intervention and inform broad national dissemination efforts to ensure that reductions in harm and improvements in quality due to antibiotic stewardship are equitably distributed, reaching all patients regardless of where they receive care.

PROJECT NARRATIVE Antibiotic overuse at hospital discharge is common, costly, and harmful. Despite evidence that discharge- specific stewardship interventions can improve antibiotic prescribing, these interventions are not feasible for most hospitals. To address this need, we will conduct a 40-hospital cluster randomized trial to evaluate the effectiveness and understand factors influencing implementation of the Reducing Overuse of Antibiotics at Discharge (ROAD) Home intervention, a participatory intervention that helps hospitals select strategies to improve their discharge antibiotic prescribing based on their needs, context, and capacity.