Optimizing Management of Urinary Tract Infections in Patients with Neurogenic Bladder through Improved Knowledge of Provider Practice and Patient-reported Outcomes

项目概要/摘要 慢性神经损伤和疾病，如脊髓损伤（SCI）、多发性硬化（MS）和 帕金森病（PD）常引起慢性膀胱功能障碍，称为“神经源性膀胱”（NB）。超过 据估计，美国有40万人患有NB。VA提供了大量的服务。 对于这些患者群体，由于其独特的重点是协调，终身护理退伍军人与复杂， 慢性残疾状况尿路感染（UTI）是NB患者的常见并发症， 可导致肾盂肾炎、败血症、肾结石，极少导致死亡。UTI管理具有挑战性，因为 细菌经常在没有感染的情况下定植在神经源性膀胱中，这种情况称为“无症状” 细菌尿”（ASB）。此外，由于膀胱受损，NB患者的UTI症状通常不典型 感觉。UTI的抗生素治疗至关重要，然而ASB的常规治疗是无益的， 导致伤害。尽管如此，许多因SCI、MS和PD而患有NB的患者在高血压的情况下管理不当， 不必要和/或不适当的抗生素使用率。[不当的UTI管理直接影响患者 康复健康，功能和生活质量，通过长期和深刻的不良后果， 抗生素耐药性和抗生素过度使用。然而，UTI管理与患者- 报告的康复结果尚未得到充分研究或明确界定。 来自CDA 2的支持将为菲茨帕特里克博士的成功职业生涯奠定必要的基础， 一名VA [康复研究员，专注于实施干预措施，以改善退伍军人的康复健康 通过优化感染性疾病管理和抗生素的使用与NB患者由于复杂，慢性， 神经损伤和疾病]。适当的UTI管理和避免不必要的抗生素是 这对于确保为这些高优先级患者提供高质量、安全的护理至关重要。这一创新项目 将研究一组在不同VA医院接受治疗的NB [由于SCI，MS和PD]患者， 地理位置和大小。它旨在描述为ASB和UTI提供的护理的变化， 使用回顾性队列研究将其与关键提供者和患者特征相关联， 健康记录数据。它进一步旨在使用定性方法来评估患者的知识，态度，信念， 以及对ASB和UTI的期望，并测量UTI相关的患者报告的康复结果。在 通过这种方式，该项目代表了在制定以患者为中心的ASB方法方面迈出的关键一步， UTI管理。本项目的结果将用于支持菲茨帕特里克博士的VA Merit评审 应用程序开发以患者为中心的多模式干预，以[改善功能和患者报告的 通过改善NB患者的ASB和UTI管理实现康复结局。]的具体组分 将通过本项目中获得的数据来了解干预措施，并针对关键患者和护理 与高比率的不当管理相关的环境。这项研究的结果也将告知未来 努力使用电子健康记录数据[开发可计算的ASB和UTI患者表型 这将有助于未来与改进ASB和UTI相关的研究和质量改进项目 管理因此，CDA 2项目的完成预计将提供关键基础， 成功干预ASB和UTI管理，改善健康，功能和生活质量， 对于退伍军人与NB由于慢性神经损伤和疾病。

Project Summary/Abstract Chronic neurologic injuries and diseases such as spinal cord injury (SCI), multiple sclerosis (MS), and Parkinson's disease (PD) often cause chronic bladder dysfunction termed `neurogenic bladder' (NB). Over 400,000 people are estimated to be living with NB in the U.S. The VA provides a significant amount of services for these patient populations, due to its unique focus on coordinated, lifelong care for Veterans with complex, chronic disabling conditions. Urinary tract infections (UTIs) are common complications in patients with NB and can cause pyelonephritis, sepsis, kidney stones, and, rarely, death. UTI management is challenging because bacteria frequently colonize a neurogenic bladder without infection, a situation called “asymptomatic bacteriuria” (ASB). Furthermore, UTI symptoms are often atypical in patients with NB due to impaired bladder sensation. Antibiotic treatment of UTIs is critical, however routine treatment of ASB is not beneficial and may lead to harm. Despite this, many patients with NB due to SCI, MS, and PD are managed improperly with high rates of unnecessary and/or inappropriate antibiotic use. [Improper UTI management directly impacts patient rehabilitative health, functioning, and quality of life via the long-term and profound adverse consequences of antibiotic resistance and antibiotic overuse.] However, the association of UTI management with patient- reported rehabilitation outcomes has not been well-studied or clearly delineated. Support from the CDA2 will provide Dr. Fitzpatrick with the necessary foundation for a successful career as a VA [rehabilitation researcher focused on implementing interventions to improve Veteran rehabilitative health by optimizing infectious diseases management and antibiotic use in patients with NB due to complex, chronic neurologic injuries and diseases.] Appropriate UTI management and avoidance of unnecessary antibiotics is critical to ensure the delivery of high quality, safe care for these high-priority patients. This innovative project will study a cohort of patients with NB [due to SCI, MS, and PD] cared for at a range of VA hospitals of varying geographic locations and sizes. It aims to characterize variations in care provided for ASB and UTI and associate them with key provider and patient characteristics using a retrospective cohort study with electronic health record data. It further aims to use qualitative methods to assess patient knowledge, attitudes, beliefs, and expectations regarding ASB and UTI and measure UTI-related patient-reported rehabilitation outcomes. In this way, the project represents a critical step forward in developing a patient-centered approach to ASB and UTI management. Results from this project will be used to support Dr. Fitzpatrick's VA Merit Review application to develop a multimodal patient-centered intervention to [improve functional and patient-reported rehabilitation outcomes via improved ASB and UTI management in patients with NB.] The specific components of the intervention will be informed by data acquired in this project and targeted to key patients and care settings associated with high rates of inappropriate management. Results from this study will also inform future efforts to use electronic health record data to [develop computable phenotypes for ASB and UTI in patients with NB] which will aid future research and quality improvement projects related to improved ASB and UTI management. Therefore, completion of this CDA2 project is expected to provide the critical groundwork leading to successful interventions for ASB and UTI management that improve health, functioning, and quality of life of for Veterans with NB due to chronic neurologic injuries and diseases.