Promoting de-implementation of inappropriate antimicrobial use in cardiac device procedures by expanding audit and feedback: protocol for hybrid III type effectiveness/implementation quasi-experimental study.
Promoting de-implementation of inappropriate antimicrobial use in cardiac device procedures by expanding audit and feedback: protocol for hybrid III type effectiveness/implementation quasi-experimental study.
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通过扩大审计和反馈：混合III类型有效性/实施准实验研究，促进心脏设备程序中不适当的抗菌使用的实施。
DOI：
10.1186/s13012-022-01186-8
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发表时间：
2022-01-29
期刊：
影响因子：
--
通讯作者：
Elwy AR
中科院分区：
文献类型：
--
作者：
Branch-Elliman W;Lamkin R;Shin M;Mull HJ;Epshtein I;Golenbock S;Schweizer ML;Colborn K;Rove J;Strymish JM;Drekonja D;Rodriguez-Barradas MC;Xu TH;Elwy AR
尽管有强有力的证据基础和临床指南特别建议不延长术后抗菌药物的使用，但研究表明，这种做法在心脏装置手术后很常见。研究小组进行的形成性评估表明，不适当的抗微生物药物使用可能是由信息孤岛驱动的，这些信息孤岛促使提供者相信抗微生物药物是无害的，部分原因是缺乏关于所有类型临床结果的完整反馈。取消实施被认为是一个重要的研究领域，可导致减少不必要、浪费或有害的做法，例如在心脏装置操作后过度使用抗微生物药物；然而，对导致成功取消执行的战略的调查是有限的。本试验要检验的首要假设是，一系列实施策略，包括对不当处方对患者造成的直接伤害进行审计和反馈，可以成功地消除与指南不一致的护理。我们建议在三家高容量、高复杂性的退伍军人医疗中心进行一项III型有效性-实施阶梯式干预试验。主要的研究干预措施（一种基于信息学的实时审计和反馈工具）是根据学习/忘记理论和形成性评价制定的，并以促进卫生服务研究实施综合行动框架（i-PARIHS）为指导。促进适当处方的捆绑和多方面实施战略的要素将包括审计和反馈报告，其中包括有关抗生素危害的信息、利益攸关方参与、患者和提供者教育、确定地方冠军和混合促进。主要研究结果是采用循证实践（停止使用不适当的抗微生物药物）。临床结果（心脏装置感染、急性肾损伤和艰难梭菌感染）是次要的。定性访谈将评估相关的实施结果（可接受性、采用率、保真度、可行性）。取消实施理论表明，可能对取消实施产生特别强烈影响的因素包括基础证据的强度、干预的复杂性以及患者和提供者对改变既定做法的焦虑和恐惧。本研究将评估针对已确定的实施障碍的多方面干预是否会导致在提供符合指南的抗微生物药物使用方面取得可衡量的改善。研究结果将有助于了解影响成功或不成功地取消有害或浪费的医疗保健做法的因素。ClinicalTrials.govNCT05020418
Despite a strong evidence base and clinical guidelines specifically recommending against prolonged post-procedural antimicrobial use, studies indicate that the practice is common following cardiac device procedures. Formative evaluations conducted by the study team suggest that inappropriate antimicrobial use may be driven by information silos that drive provider belief that antimicrobials are not harmful, in part due to lack of complete feedback about all types of clinical outcomes. De-implementation is recognized as an important area of research that can lead to reductions in unnecessary, wasteful, or harmful practices, such as excess antimicrobial use following cardiac device procedures; however, investigations into strategies that lead to successful de-implementation are limited. The overarching hypothesis to be tested in this trial is that a bundle of implementation strategies that includes audit and feedback about direct patient harms caused by inappropriate prescribing can lead to successful de-implementation of guideline-discordant care. We propose a hybrid type III effectiveness-implementation stepped-wedge intervention trial at three high-volume, high-complexity VA medical centers. The main study intervention (an informatics-based, real-time audit-and-feedback tool) was developed based on learning/unlearning theory and formative evaluations and guided by the integrated-Promoting Action on Research Implementation in Health Services (i-PARIHS) Framework. Elements of the bundled and multifaceted implementation strategy to promote appropriate prescribing will include audit-and-feedback reports that include information about antibiotic harms, stakeholder engagement, patient and provider education, identification of local champions, and blended facilitation. The primary study outcome is adoption of evidence-based practice (de-implementation of inappropriate antimicrobial use). Clinical outcomes (cardiac device infections, acute kidney injuries and Clostridioides difficile infections) are secondary. Qualitative interviews will assess relevant implementation outcomes (acceptability, adoption, fidelity, feasibility). De-implementation theory suggests that factors that may have a particularly strong influence on de-implementation include strength of the underlying evidence, the complexity of the intervention, and patient and provider anxiety and fear about changing an established practice. This study will assess whether a multifaceted intervention mapped to identified de-implementation barriers leads to measurable improvements in provision of guideline-concordant antimicrobial use. Findings will improve understanding about factors that impact successful or unsuccessful de-implementation of harmful or wasteful healthcare practices. ClinicalTrials.govNCT05020418
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