Improving antimicrobial use at hospitals that lack infectious disease specialists

改善缺乏传染病专家的医院抗菌药物的使用

• 批准号: 10295036
• 负责人: Daniel Livorsi
• 金额: --
• 依托单位: IOWA CITY VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-10-01 至 2022-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10295036
• 关键词: Accident and Emergency department; Address; Antimicrobial Resistance; Attitude; Clinic; Clinical Research; Clostridium difficile; Collaborations; Communicable Diseases; Data; Data Analyses; Databases; Development; Development Plans; Dose; Effectiveness; Ensure; Feedback; Fostering; Frequencies; Future; Goals; Health care facility; Healthcare; Hospital Administration; Hospitals; Human Resources; Improve Access; Incidence; Infection; Inpatients; Intervention; Investigation; Investigator-Initiated Research; Knowledge; Long-Term Care; Measures; Medical; Mentors; Mentorship; Methods; Modeling; Multi-Drug Resistance; Outcome; Pathway interactions; Patients; Performance; Pharmacists; Physicians; Prevalence; Process; Protocols documentation; Provider; Pseudomonas; Public Health; Qualitative Research; Randomized Controlled Trials; Research; Research Methodology; Research Personnel; Research Proposals; Resource-limited setting; Risk; Series; Site; Specialist; Surveys; Time; Training; United States Centers for Medicare and Medicaid Services; Veterans Health Administration; Work; acute care; antimicrobial; antimicrobial drug; base; carbapenem-resistant Enterobacteriaceae; career; career development; combat; community living; design; drug resistant pathogen; experience; health care settings; implementation science; improved; intervention effect; medical specialties; meetings; novel; novel strategies; pathogen; patient safety; primary outcome; programs; research and development; secondary outcome; skills; tool; treatment optimization

The primary goal of this application is to foster the development of Dr. Daniel Livorsi as an independent VHA investigator devoted to improving antimicrobial-prescribing across the continuum of healthcare. This application specifically focuses on optimizing the performance of antimicrobial stewardship programs (ASPs) in resource-limited settings. ASPs are hospital-based programs that ensure patients receive the right antimicrobial at the right dose and for the right duration. These programs have proven benefits, such as improving patient safety and reducing antimicrobial resistance. ASPs are now mandated in every VHA facility and will soon be required in non-VHA hospitals as well. The widespread implementation of robust ASPs is essential for addressing the crisis of antimicrobial resistance. Though necessary, widespread ASP implementation will be challenging. Many ASPs lack access to Infectious Disease (ID) specialists—including 23% of VHA-ASPs—and it is unclear how ASPs can be effective in such resource-limited settings. This application will begin to address this problem through an ambitious but achievable Research Plan. Project 1 will analyze antimicrobial use data from across the VHA. Multivariable analysis will be used to identify structural and process factors associated with optimal facility-level ASP performance, as measured by facility antimicrobial usage (primary outcome) and 7 secondary metrics. The goal is to identify processes that work for ASPs even in the absence of ID pharmacists and ID physicians. Facilities will also be ranked on the risk-adjusted primary outcome; high and low performers will be identified. Project 2 will use qualitative research methods to determine provider attitudes and organizational factors that impede or foster antimicrobial stewardship at 8 VHA hospitals with ASPs lacking ID support. For this project, the team will conduct research at 4 low-performing and 4 high-performing facilities, as determined by performance on the primary outcome. Project 3 will synthesize the findings from Projects 1 and 2 to develop pilot improvement strategies for low-performing ASPs that lack ID support. The model of Physician Mentored Implementation will guide this intervention, and a pretest-posttest design will be used to assess the effect of the intervention at the 2 intervention hospitals compared to 2 control hospitals. In addition to the above Research Plan, this application proposes integrated Career Development activities that build on Dr. Livorsi’s expertise in leading ASPs and his prior experience with qualitative assessments and secondary data analysis. These career development activities have the following objectives: 1) gaining fluency in the analysis of national VHA databases and the use of multilevel regression models; 2) building expertise in implementation science with a focus on qualitative assessments; and 3) developing proficiency in the conduct and analysis of multicenter interventions. These Research and Career Development plans will prepare Dr. Livorsi for submitting an Investigator-Initiated Research proposal focused on refining existing stewardship metrics. In addition, this work will set the stage for future investigations into evaluating and implementing stewardship processes in other healthcare settings, including ambulatory clinics, emergency rooms, and Community Living Centers.

该应用的主要目标是促进丹尼尔·利沃尔斯博士的发展 一个独立的VHA研究者，致力于改善整个抗菌药物的规定 医疗保健的连续性。该应用程序特别着重于优化 在资源有限的设置中，抗菌管理计划（ASP）。 ASP是基于医院的计划，可确保患者在 正确的剂量和正确的持续时间。这些计划已被证明有好处，例如 改善患者的安全性并降低抗菌素耐药性。现在授权ASP 每个VHA设施也将很快在非VHA医院中。宽度 强大的ASP的实施对于解决抗菌抗性危机至关重要。 尽管有必要，但宽度ASP实施将受到挑战。许多ASP 缺乏感染疾病（ID）专家（包括23％的VHA-ASP）的机会 尚不清楚ASP如何在此类资源有限的设置中有效。此应用程序将开始 通过雄心勃勃但成功的研究计划解决这个问题。 项目1将分析来自VHA的抗菌使用数据。多变量分析 将用于识别与最佳设施级ASP相关的结构和过程因素 通过设施抗菌用法（主要结果）和7个次要的效果 指标。目的是确定即使没有ID的过程 药剂师和ID医生。设施还将在风险调整后的主要原理上排名 结果;将确定表现高和低的人。项目2将使用定性研究 确定提供商的方法参加阻碍或促进的组织因素 8 VHA医院的ASP缺乏ID支持的抗菌管理。对于这个项目， 团队将在确定的4个低表现和4个高性能设施上进行研究 通过对主要结果的表现。项目3将综合项目1的发现 2为了制定缺乏ID支持的低绩效ASP的试点改进策略。这 医师指导实施的模型将指导这种干预措施，并进行预测试 设计将用于评估两家干预医院的干预效果 与2家对照医院相比。 除上述研究计划外，该申请提案整合了职业 基于Livorsi博士领导ASP及其先前的专业知识的发展活动 具有定性评估和次要数据分析的经验。这些职业 开发活动具有以下目标：1）在分析中流利 国家VHA数据库和多级回归模型的使用； 2）建立专业知识 实施科学，重点是定性评估； 3）培养能力 在多中心干预的行为和分析中。 这些研究和职业发展计划将为Livorsi博士做好准备 研究人员发起的研究建议着重于完善现有的管理指标。在 此外，这项工作将为未来的调查奠定阶段，以评估和实施 其他医疗机构的管理过程，包括门诊诊所，紧急情况 房间和社区生活中心。