Infection Management and Antibiotic Stewardship in Nursing Homes

疗养院的感染管理和抗生素管理

基本信息

批准号：
9060248
负责人：
PHILIP D SLOANE
金额：
$ 49.98万
依托单位：
UNIV OF NORTH CAROLINA CHAPEL HILL
依托单位国家：
美国
项目类别：
财政年份：
2014
资助国家：
美国
起止时间：
2014-05-01 至 2018-04-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9060248
关键词：
Infection Management Antibiotic Stewardship Nursing

项目摘要

DESCRIPTION (provided by applicant): Antibiotic stewardship (i.e., promotion of appropriate antibiotics to improve outcomes, reduce antibiotic resistance, and decrease the spread of multidrug-resistant organisms) is an innovation increasingly viewed as urgent for the care of nursing home (NH) residents. Reasons underlying the call for antibiotic stewardship in NHs include an increasing prevalence of healthcare-associated infections with multidrug resistant organisms, high rates of use, and estimates suggesting 25%-75% of prescriptions may not be needed. Challenges to reducing "potentially inappropriate" antibiotic use are many, however, and relate to the NH structure, prescribing processes, and patient characteristics. The proposed implementation and dissemination project builds on published evidence and our research team's success implementing a randomized controlled trial in which we reduced antibiotic prescribing by 21.3% in experimental NHs compared to 6.7% in control NHs (p=0.031). Having demonstrated efficacy, our next step is broader implementation and dissemination, but doing so requires attention to several issues. For one thing, NH chains and their associated medical practices are administered separately, and it is unclear whether innovation implementation will be more effective if the organizational point of entry is primarily through the NH organization or through medical provider practices. Further, there is reason to understand the factors associated with implementation and outcomes for both points of entry, as some NHs do not have processes in place for quality improvement (meaning that entry through medical provider practices may be more effective), and others may have diverse physicians caring for their residents (meaning that entry though the NH organization may be more effective). Another issue involves which factors within the organization of a NH and/or its medical practices are associated with implementation effectiveness (fidelity) and innovation effectiveness (outcomes), and whether these vary depending on point of entry. The proposed project will address these issues by conducting an implementation trial with two arms based on different points of entry: NH chains or medical provider practices. Based on the results of this effort, we will promote regional and national dissemination, in collaboration with a Quality Improvement Organization (QIO) and other stakeholders. Therefore, our specific aims are: (1) In a 24-month antibiotic stewardship comparative (non-randomized) implementation study in 34 NHs, with two implementation arms (NH chain focus; medical practice focus), to identify elements of the implementation approach and organizational climate that are associated with (a) implementation effectiveness (i.e., uptake and fidelity) and (b) innovation effectiveness (i.e., prescribing and health outcomes); and (2) To disseminate the program regionally and nationally. The proposed project, conducted by a team with extensive experience in this field, in collaboration with strong partners, has the potential to have national impact on this critical and complex issue.

描述（由申请人提供）：抗生素管理（即，促进适当的抗生素以改善预后，降低抗生素耐药性并减少多种耐药生物体的传播）越来越被视为迫切被视为迫切被视为迫切关注的是护理疗养院（NH）居民。 NHS呼吁进行抗生素管理的原因包括与多药耐药生物体相关的医疗相关感染的患病率越来越多，使用率高以及估计表明可能不需要25％-75％的处方。但是，减少“潜在不适当”抗生素使用的挑战很多，但与NH结构，开处方过程和患者特征有关。拟议的实施和传播项目建立在已发表的证据的基础上，我们的研究团队的成功实施了一项随机对照试验，在实验性NHS中，我们将抗生素处方降低了21.3％，而对照NHS为6.7％（P = 0.031）。表现出疗效后，我们的下一步是更广泛的实施和传播，但是这样做需要注意几个问题。一方面，NH连锁店及其相关的医疗实践是单独管理的，目前尚不清楚如果组织的进入点主要通过NH组织或通过医疗提供者实践，则创新实施是否会更有效。此外，有理由了解这两个入境点的实施和结果相关的因素，因为某些NHS没有适当的质量改进过程（这意味着通过医疗提供者实践进入可能更有效），而其他人可能会有多样化的医生在关心其居民（尽管NH组织可能会更有效，但即将进入，这意味着进入了居民）。另一个问题涉及哪些因素和/或其医疗实践组织内的因素与实施效率（Fidelity）和创新效率（结果）有关，以及这些因素是否取决于进入点。拟议的项目将通过根据不同的入境点进行两个武器的实施试验来解决这些问题：NH连锁店或医疗提供者实践。根据这项工作的结果，我们将与质量改进组织（QIO）和其他利益相关者合作促进区域和国家传播。 Therefore, our specific aims are: (1) In a 24-month antibiotic stewardship comparative (non-randomized) implementation study in 34 NHs, with two implementation arms (NH chain focus; medical practice focus), to identify elements of the implementation approach and organizational climate that are associated with (a) implementation effectiveness (i.e., uptake and fidelity) and (b) innovation effectiveness (i.e., prescribing and health结果）；（2）在区域和全国范围内传播该计划。由一个在该领域拥有丰富经验的团队与强大合作伙伴合作进行的拟议项目有可能对这个关键和复杂问题产生全国影响。