The INSPIRE-ASP UTI Trial

NCT ID: NCT03697096

Last Updated: 2025-01-30

Study Results

Results available

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Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

55412 participants

Study Classification

INTERVENTIONAL

Study Start Date

2018-10-01

Study Completion Date

2024-05-16

Brief Summary

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The INSPIRE-ASP UTI trial is a cluster-randomized controlled trial of HCA hospitals comparing routine empiric antibiotic stewardship practices with real-time precision medicine computerized physician order entry smart prompts providing the probability that a non-critically ill adult admitted with UTI is infected with a resistant pathogen.

Note: that enrolled "subjects" represents 59 individual HCA hospitals that have been randomized.

Detailed Description

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Conditions

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Urinary Tract Infection (UTI)

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

This cluster-randomized trial will assess a novel quality improvement antibiotic stewardship strategy for empiric antibiotic selection.
Primary Study Purpose

OTHER

Blinding Strategy

NONE

Study Groups

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Routine Care

Continued routine antibiotic stewardship strategies.

Group Type ACTIVE_COMPARATOR

Routine Care

Intervention Type OTHER

Routine Antibiotic Stewardship Arm - Continuation of all antibiotic stewardship activities in accordance with national standards.

INSPIRE CPOE Smart Prompt

Use of a computerized physician order entry (CPOE) smart prompt alert to guide empiric choice of antibiotics for UTI in non-ICU patients in the first 3 days of hospitalization.

Group Type ACTIVE_COMPARATOR

INSPIRE CPOE Smart Prompt

Intervention Type OTHER

Quality improvement intervention: computerized physician order entry (CPOE) decision support alert that provides physicians with patient-specific risk estimate of having a UTI due to a multidrug resistant organism (MDRO) and recommends appropriate antibiotic choice for non-ICU patients in the first 3 days of hospitalization.

Continuation of other antibiotic stewardship activities in accordance with national standards.

Interventions

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Routine Care

Routine Antibiotic Stewardship Arm - Continuation of all antibiotic stewardship activities in accordance with national standards.

Intervention Type OTHER

INSPIRE CPOE Smart Prompt

Quality improvement intervention: computerized physician order entry (CPOE) decision support alert that provides physicians with patient-specific risk estimate of having a UTI due to a multidrug resistant organism (MDRO) and recommends appropriate antibiotic choice for non-ICU patients in the first 3 days of hospitalization.

Continuation of other antibiotic stewardship activities in accordance with national standards.

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* HCA hospitals admitting adults for UTI
* Facility use of MEDITECH as their electronic health record system

Exclusion Criteria

\-

Note: unit of randomization is the hospital, however the CPOE alert intervention will calculate risk estimates for adults age \>=18 admitted to non-ICU wards and who are ordered to receive extended-spectrum antibiotics for UTI. Prisoners were excluded from prompts and analysis.
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Hospital Corporation of America

INDUSTRY

Sponsor Role collaborator

University of California, Irvine

OTHER

Sponsor Role collaborator

University of Massachusetts, Amherst

OTHER

Sponsor Role collaborator

Brigham and Women's Hospital

OTHER

Sponsor Role collaborator

Centers for Disease Control and Prevention

FED

Sponsor Role collaborator

Harvard Pilgrim Health Care

OTHER

Sponsor Role lead

Responsible Party

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Richard Platt

Professor and Chair, Department of Population Medicine

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Shruti Gohil, MD, MPH

Role: STUDY_DIRECTOR

UC Irvine Div Infectious Diseases

Susan Huang, MD, MPH

Role: PRINCIPAL_INVESTIGATOR

UC Irvine Div Infectious Diseases

Richard Platt, MD, MS

Role: PRINCIPAL_INVESTIGATOR

Harvard Pilgrim Health Care Institute

Locations

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Riverside Community Hospital

Riverside, California, United States

Site Status

Regional Medical Center of San Jose

San Jose, California, United States

Site Status

Los Robles Regional Medical Center

Thousand Oaks, California, United States

Site Status

The Medical Center of Aurora

Aurora, Colorado, United States

Site Status

Swedish Medical Center

Denver, Colorado, United States

Site Status

Sky Ridge Medical Center

Denver, Colorado, United States

Site Status

Rose Medical Center

Denver, Colorado, United States

Site Status

Brandon Hospital

Brandon, Florida, United States

Site Status

Fort Walton Medical Center

Fort Walton Beach, Florida, United States

Site Status

North Florida Regional Medical Center

Gainesville, Florida, United States

Site Status

Osceola Regional Medical Center

Kissimmee, Florida, United States

Site Status

Poinciana Medical Center

Kissimmee, Florida, United States

Site Status

Lake City Medical Center

Lake City, Florida, United States

Site Status

Largo Medical Center

Largo, Florida, United States

Site Status

Northwest Medical Center

Margate, Florida, United States

Site Status

Kendall Regional Medical Center

Miami, Florida, United States

Site Status

Twin Cities Hospital

Niceville, Florida, United States

Site Status

Putnam Community Medical Center

Palatka, Florida, United States

Site Status

Gulf Coast Medical Center

Panama City, Florida, United States

Site Status

Westside Regional Medical Center

Plantation, Florida, United States

Site Status

Fawcett Memorial Hospital

Port Charlotte, Florida, United States

Site Status

St. Lucie Medical Center

Port Saint Lucie, Florida, United States

Site Status

Central Florida Regional Hospital

Sanford, Florida, United States

Site Status

Doctor's Hospital Sarasota

Sarasota, Florida, United States

Site Status

Capital Regional Medical Center

Tallahassee, Florida, United States

Site Status

Medical Center of Trinity

Trinity, Florida, United States

Site Status

Cartersville Medical Center

Cartersville, Georgia, United States

Site Status

Fairview Park

Dublin, Georgia, United States

Site Status

Redmond Regional Medical Center

Rome, Georgia, United States

Site Status

West Valley Medical Center

Caldwell, Idaho, United States

Site Status

Terre Haute Regional Hospital

Terre Haute, Indiana, United States

Site Status

Tulane University Hospital & Clinic

New Orleans, Louisiana, United States

Site Status

Centerpoint Medical Center

Independence, Missouri, United States

Site Status

Research Medical Center

Kansas City, Missouri, United States

Site Status

Southern Hills Hospital - Vegas

Las Vegas, Nevada, United States

Site Status

TriStar Horizon Medical Center

Dickson, Tennessee, United States

Site Status

Stonecrest Medical Center

Nashville, Tennessee, United States

Site Status

South Austin Hospital

Austin, Texas, United States

Site Status

St. David's Medical Center

Austin, Texas, United States

Site Status

Valley Regional Medical Center

Brownsville, Texas, United States

Site Status

Conroe Regional Medical Center

Conroe, Texas, United States

Site Status

Corpus Christi Medical Center (Doctor's, Bay Area, and The Heart Hospital Campuses)

Corpus Christi, Texas, United States

Site Status

Medical City Denton

Denton, Texas, United States

Site Status

Medical City Fort Worth

Fort Worth, Texas, United States

Site Status

West Houston Medical Center

Houston, Texas, United States

Site Status

Kingwood Medical Center

Kingwood, Texas, United States

Site Status

Rio Grande Regional Hospital

McAllen, Texas, United States

Site Status

North Hills Hospital

North Richland Hills, Texas, United States

Site Status

Bayshore Medical Center

Pasadena, Texas, United States

Site Status

Medical City Plano

Plano, Texas, United States

Site Status

Round Rock Hospital

Round Rock, Texas, United States

Site Status

Metropolitan Methodist Hospital

San Antonio, Texas, United States

Site Status

Clearlake Regional Medical Center

Webster, Texas, United States

Site Status

LewisGale Hospital - Montgomery

Blacksburg, Virginia, United States

Site Status

John Randolph Medical Center

Hopewell, Virginia, United States

Site Status

LewisGale Hospital - Pulaski

Pulaski, Virginia, United States

Site Status

Reston Hospital

Reston, Virginia, United States

Site Status

CJW Medical Center (Chippenham & Johnston Willis Campuses)

Richmond, Virginia, United States

Site Status

Henrico Doctors' Hospital (Forest, Retreat, and Parham Campuses)

Richmond, Virginia, United States

Site Status

Countries

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United States

References

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Gohil SK, Septimus E, Kleinman K, Varma N, Avery TR, Heim L, Rahm R, Cooper WS, Cooper M, McLean LE, Nickolay NG, Weinstein RA, Burgess LH, Coady MH, Rosen E, Sljivo S, Sands KE, Moody J, Vigeant J, Rashid S, Gilbert RF, Smith KN, Carver B, Poland RE, Hickok J, Sturdevant SG, Calderwood MS, Weiland A, Kubiak DW, Reddy S, Neuhauser MM, Srinivasan A, Jernigan JA, Hayden MK, Gowda A, Eibensteiner K, Wolf R, Perlin JB, Platt R, Huang SS. Stewardship Prompts to Improve Antibiotic Selection for Urinary Tract Infection: The INSPIRE Randomized Clinical Trial. JAMA. 2024 Jun 18;331(23):2018-2028. doi: 10.1001/jama.2024.6259.

Reference Type RESULT
PMID: 38639723 (View on PubMed)

Provided Documents

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Document Type: Study Protocol

View Document

Document Type: Statistical Analysis Plan

View Document

Related Links

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Other Identifiers

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PH000619B_UTI

Identifier Type: -

Identifier Source: org_study_id

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