Dissemination and implementation of a telehealth program to deliver effective antibiotic stewardship support to rural or medically underserved newborn nurseries.

项目摘要__ 新生儿接触抗生素与显著的发病率和死亡率有关，包括感染 抗生素耐药生物、哮喘、肥胖症、代谢综合征和糖尿病等。尽管如此， 抗生素在新生儿中的滥用速度令人震惊，仍然是全球最常见的处方药 托儿所。抗生素管理计划(ASP)可以显著减少抗生素的暴露，但需要 专家支持是有效的。像许多基于证据的干预措施一样，研究之间仍然存在差距 以及广泛的实施。大多数健康的婴儿托儿所--特别是那些在农村或医疗领域的托儿所 服务不足的地区--无法获得ASP支持，这是一个重大的健康差距。可扩展 需要采取更多执行循证做法的办法，如ASP，以解决 这样的差距。远程保健已被成功地用于提供新生儿护理的其他方面，例如 复杂的护理协调和健康筛查。远程保健策略已被用于成人和儿科 ASP的努力，以及传染病远程保健支持已得到传染病协会的支持 美国协会。我们的初步研究ASSIST-1是第一个利用远程医疗提供ASP支持的研究 专门为新生儿托儿所设计的。对8个农村托儿所的ASSIST-1研究表明，远程保健ASP是 安全有效，减少32%不必要的抗生素使用。在R18健康服务研究中 示范和传播资助，我们的目标是利用传播和实施(D&I)科学来 加快向农村地区额外的1级和2级托儿所(N=40)提供基于证据的远程医疗服务 或整个德克萨斯州医疗服务不足的地区。我们的假设是，托儿所远程保健是可扩展的 采取办法，增加获得传染病护理的机会，减少不必要的抗生素接触 出生在医疗服务不足地区的新生儿。我们将使用有效性来检验我们的假设-- 基于覆盖范围、有效性、采用率、实施、 维护(RE-AIM)和实施研究综合框架(CFIR)模型以进行衡量 远程保健ASP的摄取率、有效性和可持续性。我们的具体目标是评估(1)收养情况，(2) 有效性、成本和价值，以及(3)远程医疗ASP的维护和可持续性。这项研究 团队包括新生儿传染病(Cantey博士和Duchon博士)、D&I科学(Dr.Cantey博士和Duchon博士)、 史蒂文斯和基尔佩拉)以及以患者为中心的结果和成本效益研究(Tsevat博士)。这个 拟议的研究在使用远程医疗策略将乡村医院与儿科感染联系起来方面具有创新性 疾病专家，改善对疑似或确诊感染的婴儿的护理，并将不良影响降至最低 不必要的抗生素暴露。此外，我们研究的成功实施可能随后 作为将农村托儿所与其他儿科专科医生联系起来的平台，从而减少获得护理的机会 改善医疗服务不足地区出生的婴儿的护理质量、公平性和价值。

PROJECT ABSTRACT __ Antibiotic exposure in newborns is associated with significant morbidity and mortality, including infection with antibiotic-resistant organisms, asthma, obesity, metabolic syndrome, and diabetes among others. Despite this, antibiotics are misused in neonates at alarming rates and remain the most-prescribed medications in the nursery. Antibiotic stewardship programs (ASPs) can significantly reduce antibiotic exposure but require specialist support to be effective. Like many evidence-based interventions, a gap remains between research and widespread implementation. Most well-baby nurseries – particularly those in rural or medically underserved areas – do not have access to ASP support, which is a major health disparity. Scalable approaches to increase implementation of evidence-based practices, such as ASPs, are needed to address such disparities. Telehealth has been used successfully to deliver other aspects of newborn care, such as complex care coordination and health screening. Telehealth strategies have been used in adult and pediatric ASP efforts, and telehealth for infectious diseases support has been endorsed by the Infectious Diseases Society of America. Our preliminary study, ASSIST-1, was the first to utilize telehealth to deliver ASP support specifically for newborn nurseries. The ASSIST-1 study of 8 rural nurseries showed that telehealth ASP was safe and effective, reducing unnecessary antibiotic use by 32%. In this R18 health services research demonstration and dissemination grant, we aim to use dissemination and implementation (D&I) science to accelerate delivery of our evidence-based telehealth ASP to additional level 1 and 2 nurseries (N=40) in rural or medically underserved areas throughout Texas. Our hypothesis is that nursery telehealth is a scalable approach to increase access to infectious diseases care and reduce unnecessary antibiotic exposure among newborns born in medically underserved areas. We will test our hypothesis using an effectiveness- implementation hybrid type 2 design based on the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) and Consolidated Framework for Implementation Research (CFIR) models to measure uptake, efficacy, and sustainability of the telehealth ASP. Our specific aims are to evaluate (1) the adoption, (2) the effectiveness, cost, and value, and (3) the maintenance and sustainability of the telehealth ASP. The study team includes content experts in neonatal infectious diseases (Drs. Cantey and Duchon), D&I science (Drs. Stevens and Kilpela), and patient-centered outcomes and cost-effectiveness research (Dr. Tsevat). The proposed research is innovative in its use of telehealth strategies to link rural hospitals with pediatric infectious diseases specialists, improve care for infants with suspected or proven infection, and minimize adverse effects of unnecessary antibiotic exposure. In addition, successful implementation of our study could subsequently serve as the platform for linking rural nurseries to other pediatric subspecialists, thus relieving access-to-care disparities and improving the quality, equity, and value of care for infants born in medically underserved areas.