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

项目摘要__ 新生儿抗生素暴露与显著的发病率和死亡率相关，包括感染 耐药性微生物、哮喘、肥胖、代谢综合征和糖尿病等。尽管如此， 抗生素在新生儿中以惊人的速度被滥用， 托儿所。抗生素管理计划（ASP）可以显着减少抗生素暴露，但需要 专家的支持是有效的。与许多循证干预措施一样， 广泛实施。大多数良好的婴儿托儿所-特别是那些在农村或医疗 服务不足地区-无法获得ASP支持，这是一个重大的健康差距。可扩展 需要增加实施基于证据的实践的方法，如ASP，以解决 这样的差距。远程保健已成功地用于提供新生儿护理的其他方面，例如 综合护理协调和健康检查。远程保健战略已用于成人和儿童 ASP的努力和远程保健对传染病的支持得到了传染病委员会的认可。 美国社会。我们的初步研究，ASSIST-1，是第一个利用远程医疗提供ASP支持 特别是在新生儿托儿所。对8个农村托儿所的ASSIST-1研究表明，远程保健ASP 安全有效，减少32%不必要的抗生素使用。在这项R18健康服务研究中， 示范和传播赠款，我们的目标是利用传播和实施（D&I）科学， 加速向农村地区的其他1级和2级托儿所（N=40）提供我们的循证远程保健ASP 或医疗服务不足的地区我们的假设是，托儿所远程医疗是一个可扩展的 增加获得传染病护理的机会和减少不必要的抗生素接触的方法 出生在医疗服务水平低下地区的新生儿。我们将用有效性来检验我们的假设- 实施混合型2设计基于可及性、有效性、采用、实施， 维护（RE-AIM）和实施研究综合框架（CFIR）模型来衡量 远程医疗ASP的使用、有效性和可持续性。我们的具体目标是评估（1）采用，（2） 的有效性，成本和价值，（3）远程医疗ASP的维护和可持续性。研究 团队包括新生儿传染病内容专家（Cantey和Duchon博士），D&I科学（Dr. Stevens和Kilpela），以及以患者为中心的结果和成本效益研究（Tsevat博士）。的 拟议的研究是创新的，在其使用远程保健战略，以连接农村医院与儿科传染病 疾病专家，改善对疑似或确诊感染的婴儿的护理，并尽量减少不良影响， 不必要的抗生素暴露。此外，成功实施我们的研究， 作为将农村托儿所与其他儿科专科医生联系起来的平台，从而减轻获得护理的困难 在这方面，我们必须采取措施，消除医疗服务水平低下地区的差距，提高医疗服务水平低下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.