Reducing VA Healthcare-Associated Infections through Antibiotic StEwardship (RAISE)

通过抗生素管理减少 VA 医疗保健相关感染 (RAISE)

• 批准号: 10181069
• 负责人: NASIA SAFDAR
• 金额: --
• 依托单位: WM S. MIDDLETON MEMORIAL VETERANS HOSP
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-10-01 至 2022-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10181069
• 关键词: Acceleration; Address; Antibiotics; Authorization documentation; Behavior Therapy; Caring; Case Study; Chronic; Clinical; Clostridium difficile; Complex; Data; Elderly; Engineering; Environment; Evaluation; Feedback; Fluoroquinolones; Funding; Funding Agency; Goals; Guidelines; Health Services; Health system; Hospitals; Immunocompromised Host; Incidence; Individual; Infection; Infection Control; Infection prevention; Infrastructure; Inpatients; Intensive Care Units; Interruption; Intervention; Measures; Mentors; Methods; Mission; Modeling; Needs Assessment; Outcome; Patients; Pharmacists; Positioning Attribute; Prevention; Prevention program; Randomized Controlled Trials; Recommendation; Reporting; Research; Research Design; Risk; Risk Factors; Severities; Site; Structure; System; Systems Analysis; Time Series Analysis; United States; United States Agency for Healthcare Research and Quality; Universities; Variant; Veterans; Wisconsin; Work; antimicrobial; clinical implementation; comorbidity; effective intervention; effectiveness evaluation; evidence base; experience; health care settings; healthcare-associated infections; high risk; implementation barriers; implementation facilitators; implementation outcomes; implementation science; implementation strategy; infection rate; military veteran; multi-drug resistant pathogen; patient oriented; patient population; patient safety; post intervention; prevent; programs; prospective

Background: Clostridium difficile infections (CDI) are increasing in incidence and severity, and the Veteran population is at elevated risk of this healthcare-associated infection. Despite prevention initiatives in VA, CDI rates (adjusted for facility complexity and patient mix) have continued to vary widely across VA sites. Antibiotic stewardship (AS) programs have been shown to reduce hospital-onset CDI rates, and so they are a key component of CDI prevention programs. However, it is unknown which AS strategies are most effective in reducing CDI specifically and how to implement these AS strategies effectively. Specific Aims: Our long-term goal is to use implementation science to develop and evaluate interventions to reduce healthcare-associated infections like CDI. We aim to understand the contextual and work system factors that are part of AS interventions and their impact on clinical outcomes. The Agency for Healthcare Research and Quality (AHRQ) has committed funding to our academic affiliate (PI: Safdar) to conduct a randomized controlled trial to 1) measure the impact of a core AS intervention (preprescription authorization, PPA) on reducing CDI rates and 2) use a systems engineering framework to evaluate the contextual, implementation, and work system factors that contribute to clinical outcomes. This Partnered Evaluation Initiative will leverage AHRQ funding to evaluate the clinical and implementation outcomes of a second core AS intervention with the goal of reducing CDI. Here, we will evaluate a prospective audit with feedback (PAF) AS intervention and its implementation in a VA context in order to produce implementation strategies for the specific needs of VA facilities. Our aims for this project are: 1: Evaluate implementation outcomes of a PAF intervention using a blend of the Integrated Promoting Action on Research in Health Services (PARiHS) and Systems Engineering Initiative for Patient Safety (SEIPS) models. 2: Explore the impacts of a core AS intervention (PAF) on clinical outcomes - including CDI rates - in VA settings. 3: Develop and disseminate sustainable recommendations for AS in VA aimed at reduction of CDI. Methods: We will use Mentored Implementation methods to help six VA inpatient units optimize and implement PAF interventions to reduce the use of fluoroquinolones. We will use systems engineering frameworks to evaluate the fidelity, acceptability, and feasibility of the implementations as part of a multiple case study design at each participating unit. We will also conduct an interrupted time series analysis at each site using pre- and post-intervention data to measure the impact of the intervention on clinical outcomes such as CDI rates and antibiotic usage. Impacts: This project will use the iPARiHS and SEIPS frameworks to undertake a complete work systems analysis – systematically examining implementation barriers and facilitators to AS interventions. By partnering this project with the AHRQ-funded trial, we will develop practical and applicable implementation recommendations for two core AS interventions (PPA and PAF). These implementation recommendations will fill a critical gap in AS program guidelines and will enhance CDI prevention initiatives across VA.

背景：艰难梭菌感染（CDI）的发病率和严重程度增加，老兵 这种与医疗保健相关感染的风险较高。尽管在VA中采取了预防举措，但CDI 在VA站点之间，速度（针对设施的复杂性和患者组合调整了）持续差异很大。抗生素 管理（AS）计划已显示可降低医院发作的CDI率，因此它们是关键 CDI预防计划的组成部分。但是，尚不清楚哪种策略最有效 专门降低CDI以及如何有效地实施这些策略。 具体目的：我们的长期目标是使用实施科学来制定和评估干预措施 减少与医疗保健相关的感染等感染。我们旨在了解上下文和工作系统 作为干预措施及其对临床结果的影响的因素。医疗机构 研究与质量（AHRQ）已向我们的学术分支机构（PI：SAFDAR）提供资金，以进行 随机对照试验至1）衡量核心作为干预的影响（预分量授权， ppa）关于降低CDI率和2）使用系统工程框架来评估上下文， 实施以及有助于临床结果的工作系统因素。这个合作评估 倡议将利用AHRQ资金来评估第二核的临床和实施结果 作为减少CDI的干预措施。在这里，我们将通过反馈（PAF）评估预期的审核 作为干预及其在VA环境中的实施，以制定实施策略 VA设施的特定需求。我们对该项目的目标是： 1：使用集成促进的融合来评估PAF干预的实施结果 卫生服务研究行动（PARIHS）和系统工程针对患者安全计划 （SEIPS）型号。 2：探索核心作为干预（PAF）对临床结果（包括CDI率）的影响 VA设置。 3：针对CDI减少的VA中的AS制定和传播可持续建议。 方法：我们将使用指导的实现方法来帮助六个VA住院单元优化和实施 PAF干预措施以减少氟喹诺酮类药物的使用。我们将使用系统工程框架 评估实施的保真度，可接受性和可行性，作为多重案例研究设计的一部分 在每个参与单位。我们还将使用前和 干预后数据，以衡量干预对CDI率和临床结果的影响 抗生素用法。 影响：该项目将使用IPARIH和SEIPS框架进行完整的工作系统 分析 - 系统地检查实施障碍和促进者作为干预措施。通过合作 该项目通过AHRQ资助的试验，我们将开发实际且适用的实施 针对两个核心作为干预措施的建议（PPA和PAF）。这些实施建议将 填补AS计划指南的关键空白，并将增强VA的CDI预防计划。

项目成果

Antimicrobial stewardship in solid organ transplantation: Perspective from a Veterans Affairs Medical Center.

实体器官移植中的抗菌管理：退伍军人事务医疗中心的视角。

• DOI: 10.1111/tid.13948
• 发表时间: 2022
• 期刊: Transplant infectious disease : an official journal of the Transplantation Society
• 作者: Felkner,Rebecca;Barnett,SusanneG;Misch,ElizabethA;Safdar,Nasia;Balasubramanian,Prakash
• 通讯作者: Balasubramanian,Prakash

Supporting Midcareer Women Faculty in Academic Medicine Through Mentorship and Sponsorship.

• DOI: 10.1097/ceh.0000000000000419
• 发表时间: 2022-07-01
• 期刊: JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS
• 影响因子: 1.8
• 作者: Keating, Julie A.;Jasper, Annie;Musuuza, Jackson;Templeton, Kim;Safdar, Nasia
• 通讯作者: Safdar, Nasia