Combating Antimicrobial Resistance through Rapid Implementation of Available Guidelines and Evidence (CARRIAGE)

通过快速实施现有指南和证据来对抗抗菌素耐药性 (CARRIAGE)

• 批准号: 9205309
• 负责人: CHARLESNIKA T EVANS
• 金额: --
• 依托单位: VA SALT LAKE CITY HEALTHCARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-10-01 至 2021-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9205309
• 关键词: Acute; Address; Address; Adherence; Adherence; Advisory Committees; Advisory Committees; Antibiotic Resistance; Antibiotic Resistance; Antibiotics; Antibiotics; Antimicrobial Resistance; Antimicrobial Resistance; Bacterial Antibiotic Resistance; Behavior; Behavior; Caring; Caring; Cause of Death; Cause of Death; Centers for Disease Control and Prevention (U.S.); Centers for Disease Control and Prevention (U.S.); Clinical; Clinical; Clostridium difficile; Clostridium difficile; Collaborations; Collaborations; Combating Antibiotic Resistant Bacteria; Combating Antibiotic Resistant Bacteria; Communicable Diseases; Communicable Diseases; Data; Data; Data Collection; Data Collection; Data Set; Data Set; Development; Development; Education; Education; Engineering; Engineering; Evaluation; Evaluation; Event; Event; Evidence based practice; Evidence based practice; Feedback; Feedback; Focus Groups; Focus Groups; Fostering; Fostering; Future; Future; Goals; Goals; Government Agencies; Government Agencies; Guidelines; Guidelines; Handwashing; Handwashing; Health; Health; Health Care Costs; Health Care Costs; Health Services; Health Services; Health care facility; Health care facility; Healthcare; Healthcare Systems; Healthcare Systems; Hospitals; Hospitals; Infection; Infection; Infection Control; Infection Control; Infection prevention; Infection prevention; Inpatients; Inpatients; Integrated Health Care Systems; Intervention; Intervention; Interview; Interview; Investments; Investments; Lead; Lead; Learning; Learning; Life; Life; Mentors; Mentors; Methods; Methods; Mission; Mission; Modeling; Modeling; Occupational Health; Occupational Health; Patient Care; Patient Care; Policies; Policies; Practice Guidelines; Practice Guidelines; Prevention; Prevention; Process; Process; Provider; Provider; Public Health; Public Health; Quality of Care; Quality of Care; Records; Records; Research; Research; Research Design; Research Design; Resistance; Resistance; Safety; Safety; Scientist; Scientist; Series; Series; Services; Services; Strategic Planning; Strategic Planning; Surveys; Surveys; System; System; Time; Time; Translating; Translating; Veterans; Veterans; Work; Work; acute care; antimicrobial; antimicrobial; bacterial resistance; carbapenem-resistant Enterobacteriaceae; carbapenem-resistant Enterobacteriaceae; clinical decision support; clinical practice; clinical practice; combat; combat; contextual factors; contextual factors; design; design; drug resistant pathogen; health care delivery; health care delivery; health care quality; health care quality; health care service organization; health care settings; healthcare-associated infections; implementation research; implementation research; implementation science; implementation science; implementation strategy; improved; improved; innovation; innovation; interest; interest; multi-drug resistant pathogen; multi-drug resistant pathogen; novel; novel; pathogen; pathogen; patient oriented; patient oriented; patient safety; patient safety; prevent; prevent; programs; programs; prospective; prospective; repaired; repaired; routine care; routine care; theories; theories; transmission process; transmission process; uptake; uptake

Background: Annually, at least two million illnesses and 23,000 deaths are caused by antibiotic-resistant bacteria in the US alone, with an annual impact of $20-35 billion in excess health care costs. The emergence of antibiotic resistance means the treatment of infections is becoming increasingly difficult, expensive, and, in some cases, nonexistent. Judicious use of antibiotics is essential to slow the emergence of resistance and extend the useful life of effective antibiotics, but prevention of resistance also requires efforts to control pathogen transmission across healthcare settings and reduce healthcare-associated infections. VA is not immune to this rising threat to patient safety, but our national, integrated healthcare system for Veterans offers unique opportunities to significantly alter the course of events and improve the outlook for our future through novel implementation and quality improvement efforts. Objectives: The goal of this QUERI program is to address the growing concern of antimicrobial resistance through strategies targeting improved use of antibiotics and prevention of healthcare-associated infections (HAI) across VA patient care settings. In doing so, we will address the priority goals of our VA operational partners, the QUERI Strategic Plans, the 2014 VHA Blueprint for Excellence, and the goals of the National Action Plan for Combating Antibiotic-resistant Bacteria as put forth by President Obama. Our specific objectives are to (a) promote judicious inpatient antibiotic use through a novel antibiotic self-stewardship "timeout" project that prompts VA providers to evaluate the continued need for antibiotics; (b) support and enhance the implementation of new VA guidelines to detect and prevent the spread of carbapenem-resistant Enterobacteriaceae in VA hospitals; (c) foster improved handwashing practice by repairing the broken audit- and-feedback mechanism in VA acute-care hospitals via a VISN-wide quality improvement project; and (d) evaluate and enhance the implementation of the national C. difficile bundle at VA acute-care facilities; Methods: Program projects will vary in study timeframe and start date over the five-year QUERI program timeframe. Research designs utilized across projects will include the experimental stepped wedge design for implementation of interventions, prospective observational designs of practice implementation of large-scale policy initiatives, and rigorous evaluation of VA national policies. The program will employ complementary implementation strategies and theories guided by an Implementation Core consisting of a team of notable VA implementation scientists with proven track records in designing and executing programs to control antimicrobial resistance and HAIs. Specific implementation strategies will include audit and feedback, clinical decision support, external facilitation, provider education and activation, and adherence engineering. The Promoting Action on Research in Health Services (PARiHS) framework will be used to assess contextual factors influencing implementation within facilities, while work system barriers and facilitators will be assessed using the Consolidated Framework for Implementation Research (CFIR) and the Systems Engineering Initiative for Patient Safety (SEIPS) model. Data collection methods will include the use of national VA datasets, direct observation, and primary data (i.e., surveys, interviews, and focus groups).

背景：每年至少有200万例疾病和23000例死亡是由抗生素耐药性引起的