Improving antimicrobial use at hospitals that lack infectious disease specialists

改善缺乏传染病专家的医院抗菌药物的使用

• 批准号: 9696670
• 负责人: Daniel Livorsi
• 金额: --
• 依托单位: IOWA CITY VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-10-01 至 2022-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9696670
• 关键词: Accident and Emergency department; Address; Antimicrobial Resistance; Attitude; Clinic; Clinical Research; Clostridium difficile; Collaborations; Communicable Diseases; Data; Data Analyses; Databases; Development; Development Plans; Dose; Effectiveness; Ensure; Feedback; Fostering; Frequencies; Future; Goals; Health care facility; Healthcare; Hospital Administration; Hospitals; Human Resources; Improve Access; Incidence; Infection; Inpatients; Intervention; Investigation; Investigator-Initiated Research; Knowledge; Long-Term Care; Measures; Medical; Mentors; Mentorship; Methods; Modeling; Multi-Drug Resistance; Outcome; Pathway interactions; Patients; Performance; Pharmacists; Physicians; Prevalence; Process; Protocols documentation; Provider; Pseudomonas; Public Health; Qualitative Research; Randomized Controlled Trials; Research; Research Methodology; Research Personnel; Research Proposals; Resources; Risk; Series; Site; Specialist; Structure; Surveys; Time; Training; United States Centers for Medicare and Medicaid Services; Veterans; Work; acute care; antimicrobial; antimicrobial drug; base; carbapenem-resistant Enterobacteriaceae; career; career development; combat; community living; design; drug resistant pathogen; experience; health administration; health care settings; implementation science; improved; intervention effect; medical specialties; meetings; novel; novel strategies; pathogen; patient safety; primary outcome; programs; research and development; secondary outcome; skills; tool; treatment optimization

The primary goal of this application is to foster the development of Dr. Daniel Livorsi as an independent VHA investigator devoted to improving antimicrobial-prescribing across the continuum of healthcare. This application specifically focuses on optimizing the performance of antimicrobial stewardship programs (ASPs) in resource-limited settings. ASPs are hospital-based programs that ensure patients receive the right antimicrobial at the right dose and for the right duration. These programs have proven benefits, such as improving patient safety and reducing antimicrobial resistance. ASPs are now mandated in every VHA facility and will soon be required in non-VHA hospitals as well. The widespread implementation of robust ASPs is essential for addressing the crisis of antimicrobial resistance. Though necessary, widespread ASP implementation will be challenging. Many ASPs lack access to Infectious Disease (ID) specialists—including 23% of VHA-ASPs—and it is unclear how ASPs can be effective in such resource-limited settings. This application will begin to address this problem through an ambitious but achievable Research Plan. Project 1 will analyze antimicrobial use data from across the VHA. Multivariable analysis will be used to identify structural and process factors associated with optimal facility-level ASP performance, as measured by facility antimicrobial usage (primary outcome) and 7 secondary metrics. The goal is to identify processes that work for ASPs even in the absence of ID pharmacists and ID physicians. Facilities will also be ranked on the risk-adjusted primary outcome; high and low performers will be identified. Project 2 will use qualitative research methods to determine provider attitudes and organizational factors that impede or foster antimicrobial stewardship at 8 VHA hospitals with ASPs lacking ID support. For this project, the team will conduct research at 4 low-performing and 4 high-performing facilities, as determined by performance on the primary outcome. Project 3 will synthesize the findings from Projects 1 and 2 to develop pilot improvement strategies for low-performing ASPs that lack ID support. The model of Physician Mentored Implementation will guide this intervention, and a pretest-posttest design will be used to assess the effect of the intervention at the 2 intervention hospitals compared to 2 control hospitals. In addition to the above Research Plan, this application proposes integrated Career Development activities that build on Dr. Livorsi’s expertise in leading ASPs and his prior experience with qualitative assessments and secondary data analysis. These career development activities have the following objectives: 1) gaining fluency in the analysis of national VHA databases and the use of multilevel regression models; 2) building expertise in implementation science with a focus on qualitative assessments; and 3) developing proficiency in the conduct and analysis of multicenter interventions. These Research and Career Development plans will prepare Dr. Livorsi for submitting an Investigator-Initiated Research proposal focused on refining existing stewardship metrics. In addition, this work will set the stage for future investigations into evaluating and implementing stewardship processes in other healthcare settings, including ambulatory clinics, emergency rooms, and Community Living Centers.

此应用程序的主要目标是促进Daniel Livorsi博士的发展 一名独立的VHA调查员，致力于改善整个国家的抗菌药处方 医疗保健的连续体。此应用程序特别侧重于优化 资源有限环境中的抗微生物管理计划(ASP)。 ASP是以医院为基础的计划，确保患者在 合适的剂量和合适的持续时间。这些计划已被证明有好处，例如 提高患者安全性，减少抗菌素耐药性。ASP现已在 每个VHA设施，不久非VHA医院也将需要。广为流传 实施强大的ASP对于解决抗菌素耐药性危机至关重要。 虽然有必要，但广泛的ASP实施将是具有挑战性的。多个ASP 无法获得传染病(ID)专家的帮助--包括23%的VHA-ASP--而且它是 不清楚在这种资源有限的情况下，ASP如何才能有效。此应用程序将开始 通过一个雄心勃勃但可实现的研究计划来解决这个问题。 项目1将分析整个VHA的抗菌药使用数据。多变量分析 将用于确定与最佳设施级ASP相关的结构和工艺因素 性能，通过设施抗菌剂的使用来衡量(主要结果)和7次要结果 指标。目标是确定即使在没有ID的情况下也可以为ASP工作的流程 药剂师和身份识别医生。设施也将被列为经风险调整的主要设施 结果：将确定表现高和低的人。项目2将使用定性研究 确定阻碍或促进提供者态度和组织因素的方法 8家缺乏ID支持的VHA医院的抗菌药物管理。对于这个项目， 团队将在确定的4个低性能和4个高性能设施进行研究 根据主要结果的表现。项目3将综合项目1的发现。 2为缺乏ID支持的低绩效ASP制定试点改进战略。这个 医生指导实施的模式将指导本次干预，并进行前测-后测 将使用设计来评估两家干预医院的干预效果 与2家对照医院相比。 除了上述研究计划外，本申请还提出了综合职业生涯 开发活动建立在利沃西博士领导ASP和他的前任的专业知识基础上 具有定性评估和二级数据分析的经验。这些职业生涯 发展活动有以下目标：1)流畅地分析 国家VHA数据库和多水平回归模型的使用；2)在 注重定性评估的实施科学；以及3)发展熟练程度 在进行和分析多中心干预方面发挥了重要作用。 这些研究和职业发展计划将为利沃西博士提交 一项由调查人员发起的研究提案侧重于完善现有的管理指标。在……里面 此外，这项工作将为今后对评价和执行情况的调查奠定基础 其他医疗保健环境中的管理流程，包括门诊、紧急情况 客房和社区生活中心。