Assessing the sustainability of compliance with surgical site infection prophylaxis after discontinuation of mandatory active reporting: study protocol.
Assessing the sustainability of compliance with surgical site infection prophylaxis after discontinuation of mandatory active reporting: study protocol.
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DOI：
10.1186/s43058-022-00288-0
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发表时间：
2022-04-25
影响因子：
--
通讯作者：
Mull, Hillary J.
中科院分区：
文献类型：
--
作者：
Branch-Elliman, Westyn;Elwy, A. Rani;Lamkin, Rebecca L.;Shin, Marlena;Engle, Ryann L.;Colborn, Kathryn;Rove, Jessica;Pendergast, Jacquelyn;Hederstedt, Kierstin;Hawn, Mary;Mull, Hillary J.
关键词：
手术部位感染很常见。通过适当的术前抗菌药物给药，可以大大降低风险。2005年，VA实施了外科护理改进项目（SCIP），以应对高比例的不遵守抗菌预防指南的情况。SCIP包括高风险手术中循证抗菌指南合规性指标的公开报告。SCIP非常成功，导致术前抗菌药物的采用率和术后抗菌药物的早期停用率很高（>95%）。该计划于2015年退役，因为手动测量和报告过程成本高昂，预期额外收益有限。据我们所知，没有研究评估自停止对该计划的积极支持以来，SCIP所取得的成果是否持续。此外，除了项目中包含的有限程序外，还没有对抗菌预防指南采用的传播进行调查。使用混合方法序贯探索性方法，本研究将（1）定量测量SCIP指标随时间推移的依从性，以及SCIP针对的五个主要外科专业的所有手术，（2）从利益相关者处收集定性数据，以确定有效维持依从性的策略。创新扩散理论将指导评估所取得的改进是否扩散到不包括在该计划范围内的程序。测量SCIP抗菌剂使用的电子算法将根据先前开发的方法进行调整。这些高度新颖的数据挖掘算法利用丰富的VA电子健康记录并捕获结构化和文本数据，并代表了基于药房数据的资源密集型手动图表审查或不完整的电子监控的重大技术进步。将使用中断时间序列分析评估SCIP依从性是否在项目中止后持续。将使用广义线性模型来评估在计划主动报告期间，所有SCIP目标和非目标手术中对适当预防的依从性是否按专业增加。动态可持续性框架将指导定性方法，以评估与可持续性相关的干预措施、提供者、设施、专业和背景因素。可持续性的障碍和促进因素将被映射到执行战略，这项研究将产生一个执行剧本，以指导未来的可持续努力。实践变化的可持续性被描述为临床医学中最重要但研究最少的领域之一。了解实践如何传播也是一个至关重要的调查领域。这项研究将使用新的信息学策略，以评估与可持续发展相关的因素，积极的政策监督和推进我们对这些重要的，但研究不足，领域的理解。在线版本包含补充材料，可通过10.1186/s43058-022-00288-0获得。
Surgical site infections are common. Risk can be reduced substantially with appropriate preoperative antimicrobial administration. In 2005, the VA implemented the Surgical Care Improvement Project (SCIP) in the setting of high rates of non-compliance with antimicrobial prophylaxis guidelines. SCIP included public reporting of evidenced-based antimicrobial guideline compliance metrics in high-risk surgeries. SCIP was highly successful and led to high rates of adoption of preoperative antimicrobials and early discontinuation of postoperative antimicrobials (>95%). The program was retired in 2015, as the manual measurement and reporting process was costly with limited expected additional benefit. To our knowledge, no studies have assessed whether the gains achieved by SCIP were sustained since active support for the program was discontinued. Furthermore, there has been no investigation of the spread of antimicrobial prophylaxis guideline adoption beyond the limited set of procedures that were included in the program. Using a mixed methods sequential exploratory approach, this study will (1) quantitatively measure compliance with SCIP metrics over time and across all procedures in the five major surgical specialties targeted by SCIP and (2) collect qualitative data from stakeholders to identify strategies that were effective for sustaining compliance. Diffusion of Innovation Theory will guide assessment of whether improvements achieved spread to procedures not included under the umbrella of the program. Electronic algorithms to measure SCIP antimicrobial use will be adapted from previously developed methodology. These highly novel data mining algorithms leverage the rich VA electronic health record and capture structured and text data and represent a substantial technological advancement over resource-intensive manual chart review or incomplete electronic surveillance based on pharmacy data. An interrupted time series analysis will be used to assess whether SCIP compliance was sustained following program discontinuation. Generalized linear models will be used to assess whether compliance with appropriate prophylaxis increased in all SCIP targeted and non-targeted procedures by specialty over the duration the program’s active reporting. The Dynamic Sustainability Framework will guide the qualitative methods to assess intervention, provider, facility, specialty, and contextual factors associated with sustainability over time. Barriers and facilitators to sustainability will be mapped to implementation strategies and the study will yield an implementation playbook to guide future sustainment efforts. Sustainability of practice change has been described as one of the most important, but least studied areas of clinical medicine. Learning how practices spread is also a critically important area of investigation. This study will use novel informatics strategies to evaluate factors associated with sustainability following removal of active policy surveillance and advance our understanding about these important, yet understudied, areas. The online version contains supplementary material available at 10.1186/s43058-022-00288-0.
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DOI：
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