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2.3万例死亡是由抗生素耐药引起的 仅在美国就有细菌，每年造成200-350亿美元的额外医疗成本。新出现的 抗生素耐药性的增加意味着感染的治疗变得越来越困难、昂贵，而且在 有些情况下，根本不存在。合理使用抗生素对于减缓耐药性的出现和 延长有效抗生素的使用寿命，但预防耐药性也需要努力控制 病原体在医疗保健环境中的传播，减少与医疗保健相关的感染。弗吉尼亚州不是 免疫这种对患者安全不断上升的威胁，但我们面向退伍军人的全国性集成医疗系统提供 通过以下方式显著改变事件进程并改善我们未来前景的独特机会 新颖的实施和质量改进努力。 目标：该QUERI计划的目标是解决日益增长的抗菌素耐药性问题 通过针对改善抗生素使用和预防医疗保健相关感染的战略 (HAI)跨退伍军人病患护理设置。通过这样做，我们将解决退伍军人管理局业务的优先目标 合作伙伴、QUERI战略计划、2014年VHA卓越蓝图和国家 奥巴马总统提出的抗击耐药细菌行动计划。我们的特定 目标是(A)通过一种新的抗生素自我管理，促进住院患者合理使用抗生素 “暂停”项目，促使退伍军人管理局评估抗生素的持续需求；(B)支持和 加强执行新的退伍军人管理局指南，以检测和预防耐碳青霉烯类抗生素的传播 退伍军人医院的肠杆菌科细菌；(C)通过修复损坏的审计，促进改进洗手做法- 通过VISN范围的质量改进项目，在退伍军人管理局急性护理医院建立反馈机制；和(D) 评估和加强在退伍军人管理局急性护理设施实施艰难梭菌国家包的工作； 方法：在为期五年的QUERI计划中，计划项目的研究时间框架和开始日期将有所不同 时间框架。跨项目使用的研究设计将包括试验性阶梯形楔形设计 实施干预措施、前瞻性观察性设计的实践大规模实施 政策举措，以及对退伍军人事务部国家政策的严格评估。该计划将采用补充方案 由重要的VA团队组成的实施核心指导的实施战略和理论 实施科学家，在设计和执行控制计划方面有良好的记录 抗菌药物耐药性与人类免疫缺陷。具体的实施战略将包括审计和反馈、临床 决策支持、外部促进、提供商培训和激活以及遵守工程。这个 将使用促进卫生服务研究行动(PARiHS)框架来评估背景 影响设施内实施的因素，同时将评估工作系统障碍和促进者 使用实施研究综合框架(CFIR)和系统工程 患者安全倡议(SEIPS)模式。数据收集方法将包括使用国家VA数据集， 直接观察和原始数据(即调查、访谈和焦点小组)。