Research Agenda for Antimicrobial Stewardship in the Veterans Health Administration.
Research Agenda for Antimicrobial Stewardship in the Veterans Health Administration.
复制标题
退伍军人健康管理局抗菌药物管理研究议程。
DOI：
10.1017/ice.2017.299
复制
发表时间：
2018
影响因子：
4.5
通讯作者：
Goetz,MatthewB
中科院分区：
文献类型：
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作者：
Suda,KatieJ;Livorsi,DanielJ;Goto,Michihiko;Forrest,GraemeN;Jones,MakotoM;Neuhauser,MelindaM;Hoff,BrianM;Ince,Dilek;Carrel,Margaret;Nair,Rajeshwari;Knobloch,MaryJo;Goetz,MatthewB
(See introductory commentary by Livorsi et al, pages 186–188.) Antimicrobial use is a key contributor to increasing antimicrobial resistance. 1 Antimicrobial stewardship has been shown to decrease inappropriate antimicrobial use and, in turn, may reduce antimicrobial resistance and Clostridium difficile infection (CDI). 2 Antimicrobial stewardship can also improve clinical outcomes for patients. 3 The Veterans Health Administration (VHA) is a leader in promoting antimicrobial stewardship. 4–7 Since 2011, the VHA National Antimicrobial Stewardship Taskforce (ASTF) has provided guidelines and resources for stewardship implementation at individual VHA facilities. In 2014, the VHA mandated that every facility develop and maintain an antimicrobial stewardship program (ASP). The VHA ASP Directive tasked every VHA facility to have an ASP policy, to conduct an annual evaluation of ASP activities, and to have a provider and a pharmacist champion. 6 There were no requirements for facilities to adopt any specific set of ASP activities, allowing individual facilities to decide which elements to implement based on their own focus areas and available resources. This mandate was among the first in the United States, preceding similar directives from the Joint Commission and the Centers for Medicare and Medicaid Services. 8, 9 Recently, VHA investigators have partnered with the Centers for Disease Control and Prevention (CDC) to make use of novel antimicrobial usage metrics, including the standardized antimicrobial administration ratio (SAAR). They have also utilized the robust VA Corporate Data Warehouse (CDW) to determine the effectiveness of ASPs, to evaluate outcomes, and to identify high-impact targets. 6, 7, 10–12 As the largest integrated healthcare system in the United States, the VHA provides a unique opportunity to study strategies to improve antimicrobial prescribing and the effectiveness of these interventions. Herein, we describe the proceedings from a multidisciplinary conference focused on developing an agenda for antimicrobial stewardship research in inpatient and outpatient healthcare settings within the VHA (long-term care is described separately, see commentary by Evans CT, pages 210–213). The methods are described elsewhere (see preceding editorial). The research targets were designed specifically for health services researchers within the VHA, but our findings also have implications more broadly in private sector healthcare settings (Table 1). recommendations
