{"id":"https://openalex.org/W3130113445","doi":"https://doi.org/10.1001/jamanetworkopen.2021.1072","title":"Expanding Antimicrobial Stewardship Through Quality Improvement","display_name":"Expanding Antimicrobial Stewardship Through Quality Improvement","publication_year":2021,"publication_date":"2021-02-26","ids":{"openalex":"https://openalex.org/W3130113445","doi":"https://doi.org/10.1001/jamanetworkopen.2021.1072","mag":"3130113445","pmid":"https://pubmed.ncbi.nlm.nih.gov/33635323"},"language":"en","primary_location":{"id":"doi:10.1001/jamanetworkopen.2021.1072","doi":"https://doi.org/10.1001/jamanetworkopen.2021.1072","is_oa":true,"landing_page_url":"https://doi.org/10.1001/jamanetworkopen.2021.1072","pdf_url":"https://jamanetwork.com/journals/jamanetworkopen/articlepdf/2776907/mcgregor_2021_ic_210017_1613711856.85709.pdf","source":{"id":"https://openalex.org/S4210217848","display_name":"JAMA Network Open","issn_l":"2574-3805","issn":["2574-3805"],"is_oa":true,"is_in_doaj":true,"is_core":true,"listed_in":["cwts-core","doaj","dongbi-b","doyens","jufo-1","ki-jl-2","medline","norway-1","oarl","poland-20","russia-white-list-1","vabb-shw"],"host_organization":"https://openalex.org/P4310320259","host_organization_name":"American Medical Association","host_organization_lineage":["https://openalex.org/P4310320259"],"host_organization_lineage_names":["American Medical Association"],"type":"journal"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"JAMA Network Open","raw_type":"journal-article"},"volume":null,"type":"article","indexed_in":["crossref","doaj","pubmed"],"open_access":{"is_oa":true,"oa_status":"gold","oa_url":"https://jamanetwork.com/journals/jamanetworkopen/articlepdf/2776907/mcgregor_2021_ic_210017_1613711856.85709.pdf","any_repository_has_fulltext":false},"authorships":[{"author_position":"first","author":{"id":"https://openalex.org/A5026461986","display_name":"Jessina C. McGregor","orcid":"https://orcid.org/0000-0002-6093-5444","observed_orcids":["https://orcid.org/0000-0002-6093-5444"]},"institutions":[{"id":"https://openalex.org/I131249849","display_name":"Oregon State University","ror":"https://ror.org/00ysfqy60","country_code":"US","type":"education","lineage":["https://openalex.org/I131249849"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Jessina C. McGregor","raw_affiliation_strings":["Department of Pharmacy Practice, College of Pharmacy, Oregon State University, Portland"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Department of Pharmacy Practice, College of Pharmacy, Oregon State University, Portland","institution_ids":["https://openalex.org/I131249849"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5002970304","display_name":"Margaret A. Fitzpatrick","orcid":"https://orcid.org/0000-0002-1919-9238","observed_orcids":["https://orcid.org/0000-0002-1919-9238"]},"institutions":[{"id":"https://openalex.org/I1925986","display_name":"Loyola University Chicago","ror":"https://ror.org/04b6x2g63","country_code":"US","type":"education","lineage":["https://openalex.org/I1925986"]},{"id":"https://openalex.org/I2802230104","display_name":"Edward Hines, Jr. VA Hospital","ror":"https://ror.org/02223wv31","country_code":"US","type":"healthcare","lineage":["https://openalex.org/I1322918889","https://openalex.org/I2799886695","https://openalex.org/I2802230104","https://openalex.org/I4210115976"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Margaret A. Fitzpatrick","raw_affiliation_strings":["Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr VA Hospital, Hines, Illinois","Division of Infectious Diseases, Loyola University Chicago Stritch School of Medicine, Maywood, Illinois"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr VA Hospital, Hines, Illinois","institution_ids":["https://openalex.org/I2802230104"]},{"raw_affiliation_string":"Division of Infectious Diseases, Loyola University Chicago Stritch School of Medicine, Maywood, Illinois","institution_ids":["https://openalex.org/I1925986"]}]},{"author_position":"last","author":{"id":"https://openalex.org/A5007914860","display_name":"Katie J. Suda","orcid":"https://orcid.org/0000-0002-8977-1850","observed_orcids":["https://orcid.org/0000-0002-8977-1850"]},"institutions":[{"id":"https://openalex.org/I170201317","display_name":"University of Pittsburgh","ror":"https://ror.org/01an3r305","country_code":"US","type":"education","lineage":["https://openalex.org/I170201317"]},{"id":"https://openalex.org/I4210133905","display_name":"VA Pittsburgh Healthcare System","ror":"https://ror.org/02qm18h86","country_code":"US","type":"healthcare","lineage":["https://openalex.org/I1322918889","https://openalex.org/I2799886695","https://openalex.org/I4210133905","https://openalex.org/I4210147340"]}],"countries":["US"],"is_corresponding":true,"raw_author_name":"Katie J. Suda","raw_affiliation_strings":["Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania","Division of General Internal Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania","institution_ids":["https://openalex.org/I4210133905"]},{"raw_affiliation_string":"Division of General Internal Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania","institution_ids":["https://openalex.org/I170201317"]}]}],"institutions":[],"countries_distinct_count":1,"institutions_distinct_count":5,"corresponding_author_ids":["https://openalex.org/A5007914860"],"corresponding_institution_ids":["https://openalex.org/I170201317","https://openalex.org/I4210133905"],"apc_list":{"value":3000,"currency":"USD","value_usd":3000},"apc_paid":{"value":3000,"currency":"USD","value_usd":3000},"fwci":2.7798,"has_fulltext":true,"cited_by_count":27,"citation_normalized_percentile":{"value":0.90532242,"is_in_top_1_percent":false,"is_in_top_10_percent":true},"cited_by_percentile_year":{"min":93,"max":99},"biblio":{"volume":"4","issue":"2","first_page":"e211072","last_page":"e211072"},"is_retracted":false,"is_paratext":false,"is_xpac":false,"primary_topic":{"id":"https://openalex.org/T10897","display_name":"Antibiotic Use and Resistance","score":0.9990000128746033,"subfield":{"id":"https://openalex.org/subfields/2402","display_name":"Applied Microbiology and Biotechnology"},"field":{"id":"https://openalex.org/fields/24","display_name":"Immunology and Microbiology"},"domain":{"id":"https://openalex.org/domains/1","display_name":"Life Sciences"}},"topics":[{"id":"https://openalex.org/T10897","display_name":"Antibiotic Use and Resistance","score":0.9990000128746033,"subfield":{"id":"https://openalex.org/subfields/2402","display_name":"Applied Microbiology and Biotechnology"},"field":{"id":"https://openalex.org/fields/24","display_name":"Immunology and Microbiology"},"domain":{"id":"https://openalex.org/domains/1","display_name":"Life Sciences"}},{"id":"https://openalex.org/T11000","display_name":"Infection Control in Healthcare","score":9.999999747378752e-05,"subfield":{"id":"https://openalex.org/subfields/2725","display_name":"Infectious Diseases"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T12871","display_name":"Healthcare Quality and Management","score":9.999999747378752e-05,"subfield":{"id":"https://openalex.org/subfields/3605","display_name":"Health Information Management"},"field":{"id":"https://openalex.org/fields/36","display_name":"Health Professions"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}}],"keywords":[{"id":"https://openalex.org/keywords/antimicrobial-stewardship","display_name":"antimicrobial stewardship","score":0.9739999771118164},{"id":"https://openalex.org/keywords/quality-improvement","display_name":"quality improvement","score":0.9409999847412109},{"id":"https://openalex.org/keywords/antibiotic-prescribing","display_name":"antibiotic prescribing","score":0.6179999709129333},{"id":"https://openalex.org/keywords/clostridium-difficile-infection","display_name":"Clostridium difficile infection","score":0.8529999852180481},{"id":"https://openalex.org/keywords/antimicrobial-resistance","display_name":"antimicrobial resistance","score":0.9919999837875366},{"id":"https://openalex.org/keywords/health-system-infrastructure","display_name":"health system infrastructure","score":0.40700000524520874},{"id":"https://openalex.org/keywords/intervention-implementation","display_name":"intervention implementation","score":0.33500000834465027},{"id":"https://openalex.org/keywords/patient-safety","display_name":"patient safety","score":0.578000009059906},{"id":"https://openalex.org/keywords/hospital-accreditation","display_name":"hospital accreditation","score":0.41499999165534973},{"id":"https://openalex.org/keywords/multidisciplinary-team","display_name":"multidisciplinary team","score":0.4690000116825104},{"id":"https://openalex.org/keywords/health-care-delivery-improvement","display_name":"health care delivery improvement","score":0.3930000066757202}],"concepts":[{"id":"https://openalex.org/C2776040555","wikidata":"https://www.wikidata.org/wiki/Q19903321","display_name":"Antimicrobial stewardship","level":4,"score":0.7780495882034302},{"id":"https://openalex.org/C2911146124","wikidata":"https://www.wikidata.org/wiki/Q19903321","display_name":"Antibiotic Stewardship","level":4,"score":0.7160755395889282},{"id":"https://openalex.org/C71405471","wikidata":"https://www.wikidata.org/wiki/Q757012","display_name":"Quality management","level":3,"score":0.58719801902771},{"id":"https://openalex.org/C501593827","wikidata":"https://www.wikidata.org/wiki/Q12187","display_name":"Antibiotics","level":2,"score":0.5007314682006836},{"id":"https://openalex.org/C2777950569","wikidata":"https://www.wikidata.org/wiki/Q17021836","display_name":"Stewardship (theology)","level":3,"score":0.4814583361148834},{"id":"https://openalex.org/C71924100","wikidata":"https://www.wikidata.org/wiki/Q11190","display_name":"Medicine","level":0,"score":0.4453319013118744},{"id":"https://openalex.org/C177713679","wikidata":"https://www.wikidata.org/wiki/Q679690","display_name":"Intensive care medicine","level":1,"score":0.43780213594436646},{"id":"https://openalex.org/C2779530757","wikidata":"https://www.wikidata.org/wiki/Q1207505","display_name":"Quality (philosophy)","level":2,"score":0.4188231825828552},{"id":"https://openalex.org/C4937899","wikidata":"https://www.wikidata.org/wiki/Q68541106","display_name":"Antimicrobial","level":2,"score":0.41170206665992737},{"id":"https://openalex.org/C144133560","wikidata":"https://www.wikidata.org/wiki/Q4830453","display_name":"Business","level":0,"score":0.3617086112499237},{"id":"https://openalex.org/C94665300","wikidata":"https://www.wikidata.org/wiki/Q63391344","display_name":"Antibiotic resistance","level":3,"score":0.2388300597667694},{"id":"https://openalex.org/C89423630","wikidata":"https://www.wikidata.org/wiki/Q7193","display_name":"Microbiology","level":1,"score":0.23251348733901978},{"id":"https://openalex.org/C21547014","wikidata":"https://www.wikidata.org/wiki/Q1423657","display_name":"Operations management","level":1,"score":0.23028036952018738},{"id":"https://openalex.org/C127413603","wikidata":"https://www.wikidata.org/wiki/Q11023","display_name":"Engineering","level":0,"score":0.15117818117141724},{"id":"https://openalex.org/C86803240","wikidata":"https://www.wikidata.org/wiki/Q420","display_name":"Biology","level":0,"score":0.12231221795082092},{"id":"https://openalex.org/C17744445","wikidata":"https://www.wikidata.org/wiki/Q36442","display_name":"Political science","level":0,"score":0.12161409854888916},{"id":"https://openalex.org/C198783460","wikidata":"https://www.wikidata.org/wiki/Q629173","display_name":"Management system","level":2,"score":0.05209624767303467},{"id":"https://openalex.org/C94625758","wikidata":"https://www.wikidata.org/wiki/Q7163","display_name":"Politics","level":2,"score":0.0},{"id":"https://openalex.org/C138885662","wikidata":"https://www.wikidata.org/wiki/Q5891","display_name":"Philosophy","level":0,"score":0.0},{"id":"https://openalex.org/C199539241","wikidata":"https://www.wikidata.org/wiki/Q7748","display_name":"Law","level":1,"score":0.0},{"id":"https://openalex.org/C111472728","wikidata":"https://www.wikidata.org/wiki/Q9471","display_name":"Epistemology","level":1,"score":0.0}],"mesh":[{"descriptor_ui":"D000073602","descriptor_name":"Antimicrobial Stewardship","qualifier_ui":null,"qualifier_name":null,"is_major_topic":true},{"descriptor_ui":"D000082682","descriptor_name":"Clostridioides","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D000900","descriptor_name":"Anti-Bacterial Agents","qualifier_ui":"Q000627","qualifier_name":"therapeutic use","is_major_topic":false},{"descriptor_ui":"D006761","descriptor_name":"Hospitals","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D006801","descriptor_name":"Humans","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D058996","descriptor_name":"Quality Improvement","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false}],"locations_count":2,"locations":[{"id":"doi:10.1001/jamanetworkopen.2021.1072","doi":"https://doi.org/10.1001/jamanetworkopen.2021.1072","is_oa":true,"landing_page_url":"https://doi.org/10.1001/jamanetworkopen.2021.1072","pdf_url":"https://jamanetwork.com/journals/jamanetworkopen/articlepdf/2776907/mcgregor_2021_ic_210017_1613711856.85709.pdf","source":{"id":"https://openalex.org/S4210217848","display_name":"JAMA Network Open","issn_l":"2574-3805","issn":["2574-3805"],"is_oa":true,"is_in_doaj":true,"is_core":true,"listed_in":["cwts-core","doaj","dongbi-b","doyens","jufo-1","ki-jl-2","medline","norway-1","oarl","poland-20","russia-white-list-1","vabb-shw"],"host_organization":"https://openalex.org/P4310320259","host_organization_name":"American Medical Association","host_organization_lineage":["https://openalex.org/P4310320259"],"host_organization_lineage_names":["American Medical Association"],"type":"journal"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"JAMA Network Open","raw_type":"journal-article"},{"id":"pmid:33635323","doi":null,"is_oa":false,"landing_page_url":"https://pubmed.ncbi.nlm.nih.gov/33635323","pdf_url":null,"source":{"id":"https://openalex.org/S4306525036","display_name":"PubMed","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":"https://openalex.org/I1299303238","host_organization_name":"National Institutes of Health","host_organization_lineage":["https://openalex.org/I1299303238"],"host_organization_lineage_names":[],"type":"repository"},"license":null,"license_id":null,"version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"JAMA network open","raw_type":"Journal Article"}],"best_oa_location":{"id":"doi:10.1001/jamanetworkopen.2021.1072","doi":"https://doi.org/10.1001/jamanetworkopen.2021.1072","is_oa":true,"landing_page_url":"https://doi.org/10.1001/jamanetworkopen.2021.1072","pdf_url":"https://jamanetwork.com/journals/jamanetworkopen/articlepdf/2776907/mcgregor_2021_ic_210017_1613711856.85709.pdf","source":{"id":"https://openalex.org/S4210217848","display_name":"JAMA Network Open","issn_l":"2574-3805","issn":["2574-3805"],"is_oa":true,"is_in_doaj":true,"is_core":true,"listed_in":["cwts-core","doaj","dongbi-b","doyens","jufo-1","ki-jl-2","medline","norway-1","oarl","poland-20","russia-white-list-1","vabb-shw"],"host_organization":"https://openalex.org/P4310320259","host_organization_name":"American Medical Association","host_organization_lineage":["https://openalex.org/P4310320259"],"host_organization_lineage_names":["American Medical Association"],"type":"journal"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"JAMA Network Open","raw_type":"journal-article"},"sustainable_development_goals":[{"score":0.9763000011444092,"id":"https://metadata.un.org/sdg/3","display_name":"Good health and well-being"}],"study_designs":[],"awards":[],"funders":[],"has_content":{"pdf":true,"grobid_xml":true},"content_urls":{"pdf":"https://content.openalex.org/works/W3130113445.pdf","grobid_xml":"https://content.openalex.org/works/W3130113445.grobid-xml"},"referenced_works_count":4,"referenced_works":["https://openalex.org/W2117449176","https://openalex.org/W2337544276","https://openalex.org/W2580434491","https://openalex.org/W3131032918"],"related_works":["https://openalex.org/W4256553860","https://openalex.org/W4299832843","https://openalex.org/W2028467247","https://openalex.org/W4200441501","https://openalex.org/W4285602185","https://openalex.org/W1506742732","https://openalex.org/W4225314108","https://openalex.org/W2084584294","https://openalex.org/W7097208310","https://openalex.org/W4401597781"],"abstract_inverted_index":{"Quality":[0,427],"improvement,":[1,175],"the":[2,38,134,138,222,261,268,306,309,314,336,339,361,364,373,388,395,413,425,448,475,485,515,518],"systematic":[3],"process":[4],"to":[5,49,62,71,116,119,132,142,155,180,185,210,220,237,263,354,462,474,481,503],"improve":[6,50,72,156,186,211],"health":[7,14,32,51,122,232,326,422],"care":[8,98,123,352],"delivery,":[9],"has":[10,429,455,472],"become":[11],"ubiquitous":[12],"in":[13,285,484,527],"care.Quality":[15],"improvement":[16,28,35,61,77,88,128,203,442,522],"focuses":[17],"on":[18,57,96,190,494,514],"a":[19,69,100,151,384,457],"modest":[20],"concept:":[21],"that":[22,512],"we":[23],"all":[24,350],"have":[25,79],"room":[26],"for":[27,251,343,349,375,397,416,432,444,450],"as":[29,44,301,305,381,383,440],"clinicians":[30,162],"and":[31,46,65,75,87,124,145,157,163,192,195,204,228,248,255,266,332,359,378,394,435,447,470],"systems.The":[33],"quality":[34,58,174,202,441,521],"literature":[36],"emphasizes":[37],"use":[39,165,438,446],"of":[40,99,137,153,201,216,224,270,280,308,316,363,367,392,400,467,477,490,517],"simple":[41],"interventions,":[42,194],"such":[43,300],"checklists":[45],"performance":[47,60],"reports,":[48],"care.Entire":[52],"departments":[53,78,129],"now":[54],"exist":[55],"focused":[56,95],"or":[59,288,322],"meet":[63],"regulatory":[64],"accreditation":[66,330,406],"standards":[67],"with":[68,173,241],"goal":[70,200],"patient":[73,106,212],"outcomes":[74],"safety.Quality":[76],"robust":[80,235],"infrastructure":[81,90,236],"including":[82,176],"information":[83,245],"technology,":[84],"data":[85],"scientists,":[86],"specialists.This":[89],"supports":[91],"multiple":[92],"interprofessional":[93],"teams":[94,112],"improving":[97],"condition":[101],"(eg,":[102,109],"heart":[103],"failure)":[104],"and/or":[105],"safety":[107],"issue":[108],"fall":[110],"prevention).These":[111],"adapt":[113],"different":[114],"approaches":[115],"identify":[117],"strategies":[118,154,184],"support":[120,238,250],"evidencebased":[121],"determine":[125,267],"intervention":[126],"effectiveness.Quality":[127],"are":[130,219,282],"necessary":[131],"navigate":[133],"unique":[135],"complexities":[136],"facility's":[139],"implementation":[140,497],"context":[141,489],"develop,":[143,264],"deploy,":[144,265],"sustain":[146],"successful":[147],"interventions.Antimicrobial":[148],"stewardship":[149,168,206,218,272,277,293,318,357,370,479,496,524],"is":[150,207,273,500],"set":[152],"measure":[158],"antibiotic":[159,164,187,369,437,445],"prescribing":[160],"by":[161,166,275,387,409,507],"patients.Antimicrobial":[167],"shares":[169],"many":[170],"common":[171],"elements":[172,366],"identifying":[177],"what":[178],"needs":[179],"be":[181],"improved,":[182],"implementing":[183],"prescribing,":[188],"focusing":[189],"feasible":[191],"high-impact":[193],"measuring":[196],"program":[197,289,525],"outcomes.The":[198],"ultimate":[199],"antimicrobial":[205,217,229,239,271,276,317,356,478,495,523],"also":[208],"similar:":[209],"safety.Major":[213],"long-term":[214],"goals":[215],"decrease":[221],"development":[223],"Clostridioides":[225],"difficile":[226],"infection":[227],"resistance.Unfortunately,":[230],"most":[231,482],"systems":[233],"lack":[234],"stewardship,":[240],"few":[242,279],"hospitals":[243,353,483],"providing":[244],"technology":[246],"personnel":[247],"salary":[249],"infectious":[252,286],"diseases":[253,287],"pharmacists":[254],"physicians.":[256],"1":[257,380],"Without":[258],"this":[259,488,505],"support,":[260],"work":[262,310],"effectiveness":[269],"shouldered":[274],"leaders,":[278],"whom":[281],"specialty":[283],"trained":[284],"evaluation.":[290],"2":[291,511],"Antimicrobial":[292],"programs":[294,319,358,371,480],"first":[295],"emerged":[296],"among":[297],"high-resource":[298],"institutions,":[299],"academic":[302],"medical":[303],"centers.However,":[304],"importance":[307],"gained":[311],"heightened":[312],"awareness,":[313],"establishment":[315],"was":[320],"encouraged":[321],"required":[323],"through":[324],"public":[325],"recommendations,":[327],"state":[328],"laws,":[329],"requirements,":[331,469],"payor":[333],"policies.In":[334],"2015,":[335],"US":[337,421],"released":[338],"\"National":[340],"Action":[341],"Plan":[342],"Combatting":[344],"Antibiotic-Resistant":[345],"Bacteria,\"":[346],"which":[347],"called":[348],"acute":[351],"implement":[355],"prompted":[360],"release":[362],"core":[365],"hospital":[368],"from":[372],"Centers":[374,431,449],"Disease":[376,433],"Control":[377,434],"Prevention,":[379],"well":[382],"joint":[385],"guideline":[386],"Infectious":[389],"Diseases":[390],"Society":[391,396],"America":[393],"Healthcare":[398],"Epidemiology":[399],"America.3":[401],"These":[402],"recommendations":[403],"subsequently":[404],"informed":[405],"requirements":[407],"implemented":[408],"The":[410],"Joint":[411],"Commission,":[412],"accrediting":[414],"body":[415],"more":[417],"than":[418],"22":[419],"000":[420],"systems.4":[423],"Currently,":[424],"National":[426],"Forum":[428],"endorsed":[430],"Prevention":[436],"metrics":[439],"measures":[443,461],"Medicare":[451],"&":[452],"Medicaid":[453],"Services":[454],"proposed":[456],"rule":[458],"tying":[459],"these":[460],"reimbursement":[463],"policy.5":[464],"This":[465],"evolution":[466],"regulations,":[468],"guidance":[471],"led":[473],"expansion":[476],"US.":[486],"6Within":[487],"an":[491],"increasing":[492],"focus":[493],"nationwide,":[498],"it":[499],"particularly":[501],"relevant":[502],"consider":[504],"study":[506],"Tamma":[508],"et":[509],"al":[510],"reports":[513],"success":[516],"largest":[519],"pragmatic":[520],"initiative":[526],"+":[528]},"counts_by_year":[{"year":2026,"cited_by_count":3},{"year":2025,"cited_by_count":5},{"year":2024,"cited_by_count":8},{"year":2023,"cited_by_count":5},{"year":2022,"cited_by_count":4},{"year":2021,"cited_by_count":2}],"updated_date":"2026-10-31T12:09:11.096373","created_date":"2021-03-01T00:00:00"}
