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: 10187395
• 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: 2021
• 资助国家: 美国
• 起止时间: 2021-10-01 至 2025-09-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10187395
• 关键词: 2019-nCoV; Address; Adoption; Advisory Committees; Antibiotic Resistance; Antibiotics; Antimicrobial Resistance; Area; Behavior; COVID-19; COVID-19 pandemic; Caring; Centers for Disease Control and Prevention (U.S.); Cessation of life; Characteristics; Clinical; Collaborations; Communicable Diseases; Country; Data; Data Collection; Data Set; Development; Development Plans; Disease; Disease Resistance; Disinfection; Education; Emerging Communicable Diseases; Engineering; Ensure; Evaluation; Event; Evidence based practice; Exhibits; Feedback; Focus Groups; Future; Generations; Goals; Guidelines; Health; Health care facility; Healthcare; Healthcare Systems; ImProv; Individual; Infection; Infection Control; Infection prevention; Infrastructure; Integrated Health Care Systems; Intervention; Interview; Investments; Leadership; Mentors; Methods; Mission; Modeling; Modernization; Morbidity - disease rate; Organism; Outcome; Patient Care; Performance; Phase; Policies; Positioning Attribute; Prevention; Process; Provider; Public Health; Quality of Care; Recording of previous events; Records; Reporting; Research; Research Personnel; Resistance; Safety; Scientist; Secondary to; Series; Services; Site; Surveys; System; Testing; Time; Touch sensation; Training; Treatment Failure; Uncertainty; United States; Veterans; Work; antimicrobial; carbapenem resistance; career; career development; cost; design; drug resistant pathogen; effectiveness evaluation; emerging pathogen; experience; health care quality; health care settings; healthcare-associated infections; implementation science; implementation strategy; improved; innovation; interest; mortality; multi-drug resistant pathogen; novel; pandemic disease; pathogen; patient safety; prevent; programs; resilience; response; routine care; success; theories; transmission process; ultraviolet; uptake

Background: Under-investments in antimicrobial discovery, antimicrobial stewardship, and infection control have reached crisis proportions. While these under-investments have been laid bare by SARS-CoV-2, antimi- crobial-resistant infections—a more silent killer—are accelerating with three million illnesses, 48,000 deaths and $35 billion in excess costs annually in the US, secondary to treatment failure and associated higher morbidity and mortality. The ongoing pandemic of COVID-19, the disease caused by SARS-CoV-2, has also revealed much about the limits of our public health infrastructure and the need to rapidly engage partners, dis- seminate best practices, and adapt to changing conditions during times of widespread uncertainty. 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 continue the successes of its predecessor by addressing the growing concern of antimicrobial resistance and other emerging infectious threats through strategies that train, communicate, and coordinate front-line staff, operational leaders, and field experts. In doing so, we will address the priority goals of our VA operational partners, increase the impact of VA research findings through bi-directional partnerships and rigorous evaluation, and promote VA as a high reliability organization through innovative implementation science. Three projects designed to implement key evidence-based practices in the areas of infection prevention, biosurveillance, and antimicrobial stewardship will target the behaviors and processes that facilitate the spread of antibiotic-resistant and other emerging pathogens, including (1) improv- ing patient safety through overcoming barriers to Ultraviolet-C (UVC) no-touch room disinfection; (2) improving implementation of strategies to prevent the spread of carbapenem-resistant organisms (CROs); and (3) estimating the impact of two different electronic audit and feedback strategies on antimicrobial prescribing practices. These efforts will be supplemented with time-sensitive rapid response projects guided by our operational partners to assist their work with front-line providers across the country. We will also train a new generation of VA implementation scientists through our mentoring core, led by investigators committed to developing junior implementation researchers committed to careers improving the quality, safety, and value of Veteran health care. Methods: 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 prevent the spread of pathogens. We will follow the principles of High Reliability Organizations to deliver reliable performance, consistent safety, and exceptional quality, using approaches that are aligned with the three phases of the QUERI Implementation Roadmap (pre-implementation, implementation, and sustainment). Specific implementation strategies will include blended (internal and external) facilitation, audit and feedback, and provider and staff education and activation. Work system barriers and facilitators will be assessed using the Systems Engineering Initiative for Patient Safety (SEIPS) model, which will help identify factors that influence the processes of care and inform data collection methods that will include the use of national VA datasets, direct observation, and primary data (i.e., surveys, interviews, and focus groups). Finally, our Mentoring Core will utilize the Matrix Mentoring Model as a framework to provide each trainee with a team of mentors, each contributing unique expertise. Trainees will follow a personalized career development plan, and will have opportunities to participate in rapid response projects to gain experience interfacing with VA operational partners.

背景：在抗菌药物发现、抗菌药物管理和感染控制方面的投资不足 已经达到了危机的程度。虽然这些投资不足已被SARS-CoV-2暴露出来，但抗- 耐crobial感染-一个更沉默的制造者-正在加速，300万人患病，48，000人死亡 在美国，每年的额外费用为350亿美元，其次是治疗失败和相关的更高费用。 发病率和死亡率。由SARS-CoV-2引起的COVID-19的持续流行也 揭示了我们公共卫生基础设施的局限性，以及迅速与合作伙伴合作的必要性， 传播最佳实践，并在广泛的不确定性时期适应不断变化的条件。我们 国家综合退伍军人医疗保健系统为显着改变进程提供了独特的机会 通过创新的实施和质量改进努力，改善我们未来的前景。 目标：该QUERI计划的目标是通过解决以下问题，继续其前身的成功 对抗菌素耐药性和其他新出现的传染病威胁的日益关注， 沟通，并协调前线工作人员，业务领导人和现场专家。为此，我们将 解决我们的VA业务合作伙伴的优先目标，通过以下方式增加VA研究结果的影响 双向合作伙伴关系和严格的评估，并通过以下方式促进VA成为一个高可靠性组织： 创新实施科学。三个项目旨在实施关键的循证做法， 感染预防、生物监测和抗菌管理领域将针对这些行为， 促进耐药性和其他新出现的病原体传播的过程，包括（1）改进， 通过克服紫外线-C（UVC）无接触房间消毒的障碍来提高患者安全;（2）提高 实施防止碳青霉烯类耐药微生物（CROs）传播的策略;和（3） 评估两种不同的电子审计和反馈策略对抗菌药物处方的影响 实践这些努力将辅之以在我们的指导下进行的具有时间敏感性的快速反应项目。 业务伙伴协助他们与全国各地的一线供应商合作。我们还将培养一个新的 通过我们的指导核心，由致力于以下方面的调查人员领导， 发展初级实施研究人员致力于提高职业生涯的质量，安全性和价值， 退伍军人医疗保健。 方法：该计划将采用互补的实施策略和理论， 实施核心由一组著名的VA实施科学家组成，他们在以下方面拥有良好的业绩记录： 设计和执行控制抗菌素耐药性和防止病原体传播的方案。我们 将遵循高可靠性组织的原则，以提供可靠的性能，一致的安全性， 采用与QUERI实施的三个阶段相一致的方法，实现卓越的质量 路线图（实施前、实施和维持）。具体实施战略将 包括混合（内部和外部）促进、审计和反馈，以及提供者和工作人员教育， activation.工作系统的障碍和促进因素将使用系统工程倡议进行评估， 患者安全（SEIPS）模型，这将有助于确定影响护理过程的因素，并告知 数据收集方法，包括使用国家VA数据集、直接观测和原始数据 (i.e.,调查、访谈和焦点小组）。最后，我们的指导核心将利用矩阵指导模型 作为一个框架，为每个学员提供一个导师团队，每个人都贡献了独特的专业知识。学员 将遵循个性化的职业发展计划，并将有机会参与快速反应 项目，以获得与VA运营合作伙伴的经验。