New Grant will Test Novel Ways to Improve Diagnosis and Treatment of Urinary Tract Infections in Older Adults

Kimberly Claeys, PharmD, PhD, an infectious disease pharmacist, will lead a multidisciplinary team focused on incorporating the 4Ms of age-friendly care to improve clinician workflow and patient outcomes in older adults with suspected UTI.

By Becky Ceraul
November 4, 2024

The Institute for Healthcare Improvement (IHI) has awarded a $100,000 grant to an infectious disease pharmacist at the University of Maryland School of Pharmacy to work with collaborators to implement a urinary tract infection (UTI) diagnosis and management intervention that will holistically incorporate the 4Ms of age-friendly care to improve clinician workflow and patient outcomes for veterans receiving care within Community Living Centers of the Veterans Affairs Maryland Healthcare System (VAMHCS).

Kimberly Claeys, PharmD, PhD, an associate professor of practice, sciences, and health outcomes research, will work with colleagues from the School of Pharmacy’s Peter Lamy on Drug Therapy and Aging, the University of Maryland School of Medicine’s (UMSOM) Center for Innovation in Diagnosis, and the VAMHCS on the grant from IHI’s Diagnostic Excellence – Age-Friendly Health Systems Seed Grant Program, which is supported by the Gordon and Betty Moore Foundation and The John A. Hartford Foundation.

“UTIs account for 25 percent of all infections among older adults, but diagnosis in this patient population is extremely challenging,” says Claeys, who is an expert in antimicrobial stewardship. “Older adults frequently have bacteria present in their urine without the presence of infection, a condition called asymptomatic bacteriuria (ASB). The antibiotics used to treat ASB can lead to colonization of drug-resistant bacteria or adverse drug events. Our research project aims to develop a workflow and standard approach to improve the diagnosis of UTIs in older adults and subsequently improve antibiotic use in this patient population.

In addition to her Doctor of Pharmacy (PharmD) degree and infectious disease fellowship training, Claeys has a PhD in epidemiology with a focus on diagnostic stewardship. She is co-chair of the University of Maryland Medical System’s Sepsis Program Rapid Diagnostics Working Group, a Fellow of UMSOM’s Center for Innovation in Diagnosis, and a Scholar in Diagnostic Excellence through the National Academy of Medicine.

Claeys’ research focuses on the intersection of diagnostic and antimicrobial stewardship, finding ways to improve diagnosis and, subsequently, antimicrobial management. She has completed several projects on improving diagnosis of UTIs and subsequently decreasing treatment of ASB, particularly within the Veterans Affairs health care system both locally and nationally.

“Although many components of age-friendly care already occur within the VAMHCS, formalizing a standardized or streamlined method of diagnosing, documenting, and managing UTIs and ASB can help build on that expertise as well as inform other long term care partners,” Claeys says. “Our team is working within VA nursing homes known as Community Living Centers to develop and refine an interdisciplinary intervention that incorporates the 4Ms (what Matters, Medication, Mentation, and Mobility) to address diagnostic safety events and improve the care of older adults. This includes both provider and patient engagement.”

IHI is a leading, globally recognized not-for-profit health care improvement organization that has been applying evidence-based quality improvement methods to meet current and future health care challenges for more than 30 years. IHI provides millions of people in health care with methods, tools, and resources to make care better, safer, and more equitable; convenes experts to enable knowledge sharing and peer-learning; and advises health systems and hospitals of all sizes in improving their systems and outcomes at scale. IHI’s mission is to innovate and lead transformational improvement in health and health care worldwide.

The seven grantees selected for IHI’s Diagnostic Excellence – Age-Friendly Health Systems Seed Grant Program were chosen for their ability to support non-geriatricians in various settings, foster meaningful engagement of older adult patients and families, and improve equity and mitigate disparities including ageism, race/ethnicity, gender, and/or social determinants of health. During the 21-month grant period, the network will facilitate learning among the grantees and support integration of quality improvement in all projects.

“Dr. Claeys’ study has the potential to improve diagnostic tests as well as Age Friendly workflow and efforts to address both the over-treatment or undertreatment of UTIs that have significant consequences such as antibiotic resistance and increased morbidity/mortality,” says Nicole Brandt, PharmD, MBA, professor of P-SHOR and executive director of the School of Pharmacy’s Peter Lamy Center on Drug Therapy and Aging, who is serving as an advisor on the grant. “Her work relates to the Lamy Center’s Leveraging Age-Friendly Pharmacists initiative in highlighting the 4Ms in an interprofessional way to improve the delivery of care and outcomes that matter in a different care setting.”