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

项目摘要/摘要 慢性神经损伤和疾病，如脊髓损伤(SCI)、多发性硬化症(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)。完毕 据估计，美国有40万人患有NB。退伍军人管理局提供了大量的服务 对于这些患者群体，由于其独特的关注协调，终身护理退伍军人复杂， 慢性致残状态。尿路感染(UTIs)是NB患者常见的并发症。 可导致肾盂肾炎、败血症、肾结石，极少数情况下会导致死亡。UTI管理具有挑战性，因为 细菌经常在神经性膀胱内定植而不感染，这种情况称为“无症状” 细菌尿症“(ASB)。此外，由于膀胱受损，NB患者的尿路感染症状通常不典型。 轰动一时。尿路感染的抗生素治疗是至关重要的，但常规的ASB治疗无益，可能 导致伤害。尽管如此，许多因脊髓损伤、多发性硬化症和帕金森病而患有NB的患者处理不当，并伴有高 不必要和/或不适当的抗生素使用率。[不恰当的UTI管理直接影响患者 通过长期和深刻的不良后果恢复健康、功能和生活质量 抗生素耐药性和抗生素过度使用。]然而，尿路感染管理与患者的联系- 已报道的康复结果没有得到很好的研究或清楚地描述。 CDA2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 一位康复研究人员专注于实施干预措施以改善退伍军人康复健康 通过优化传染病管理和抗生素使用，改善因复杂、慢性疾病而导致的NB患者 神经损伤和疾病。]适当的尿路感染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。这个创新的项目 将研究一组[由于脊髓损伤、多发性硬化症和帕金森病]在退伍军人事务部不同医院接受治疗的NB患者 地理位置和大小。它的目的是描述为ASB和UTI提供的护理的差异，以及 使用电子产品的回溯性队列研究，将它们与关键提供者和患者特征相关联 健康记录数据。它还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，并衡量与UTI相关的患者报告的康复结果。在……里面 这样，该项目代表着在开发以患者为中心的ASB方法和 UTI管理层。该项目的结果将用于支持菲茨帕特里克博士的退伍军人事务部功绩评估 开发以患者为中心的多模式干预的应用程序[改善功能和患者报告 通过改进ASB和UTI管理改善NB患者的康复结果。]具体的组件 将通过在该项目中获得的、针对关键患者和护理的数据来了解干预的情况 与不适当管理的高比率相关的设置。这项研究的结果也将为未来 努力使用电子健康记录数据[开发ASB和UTI患者的可计算表型 这将有助于与改进的ASB和UTI相关的未来研究和质量改进项目 管理层。因此，CDA2项目的完成预计将提供关键的基础领导 对于ASB和UTI管理的成功干预，改善了患者的健康、功能和生活质量 适用于因慢性神经损伤和疾病而患神经衰弱的退伍军人。

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.