Dissemination and Implementation of a Videoconference Antimicrobial Stewardship Team (VAST)

视频会议抗菌管理团队 (VAST) 的传播和实施

• 批准号: 10672768
• 负责人: CHARLESNIKA T EVANS
• 金额: --
• 依托单位: EDWARD HINES JR VA HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-10-01 至 2024-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10672768
• 关键词: Accounting; Acute respiratory infection; Address; Advisory Committees; African American population; Age; Ambulatory Care Facilities; Antibiotics; Antimicrobial Resistance; Bacteria; Bacteriuria; Categories; Characteristics; Chronic; Clinical; Clinical Practice Guideline; Collaborations; Communicable Diseases; Communication; Complex; Data; Development; Diagnosis; Diagnostic; Disparity; Dissemination and Implementation; Elements; Ethnic Origin; Ethnic Population; Evaluation; Event; Feedback; Goals; Guidelines; Health; Health Disparities Research; Health Promotion; Health Services; Health system; Healthcare; Hispanic Populations; Hospitals; Infection; Infection Control; Infection prevention; Intervention; Logistic Regressions; Medical; Medical Electronics; Medical center; Mentors; Mentorship; Methodology; Modeling; Nature; Nose; Nurses; Outpatients; Parents; Patients; Persons; Pharmacists; Pharyngeal structure; Physicians; Play; Predictive Factor; Process; Provider; Race; Random Allocation; Recommendation; Reporting; Research; Research Personnel; Resistance; Retrospective cohort; Retrospective cohort study; Robin bird; Role; Rural; Rural Health; Sampling; Scientist; Series; Signs and Symptoms; Site; Societies; Specialist; System; Uninsured; United States; Urinary tract infection; Urine; Veterans; Videoconferencing; Viral; Work; acute infection; antimicrobial; career; cohort; design; experience; follow-up; geographically distant; global health; health disparity; health equity; human old age (65+); improved; innovation; interdisciplinary approach; meetings; multi-drug resistant pathogen; operation; pathogen; prevent; programs; racial population; statistics; telehealth; tool; videoconference

Background: Antimicrobial-resistant and healthcare-associated pathogens are a serious threat in the United States, accounting for over 3 million infections each year. Antimicrobial stewardship remains the strongest tool in reducing the over prescribing of antibiotics, the leading modifiable cause of resistance. Despite this, inappropriate antibiotic use is still common in the VA. Furthermore, little is known about the role health disparities play in antibiotic inappropriate antibiotic prescribing. Significance: This proposal is highly significant for Veterans and the goals of VA. Previous studies have shown that additional antimicrobial stewardship efforts are needed in VA outpatient settings. Additionally, this project will provide evidence on health disparities and system factors that can be targeted in interventions to improve VA outpatient antibiotic prescribing. This project is aligned with the priorities of our operation partners: the VA Antimicrobial Stewardship Task Force and the Office of Rural Health. Specific Aims: The goal of this proposal will be to evaluate the patient and system factors that drive inappropriate antibiotic prescribing at the Videoconferencing Antimicrobial Stewardship Team (VAST) study sites using integrated health disparities and antimicrobial stewardship frameworks. Aim 1: Determine the percentage of antibiotic over-prescribing and under-prescribing for acute respiratory infections that occur by Veteran's race/ethnicity in VAST sites. Aim 2: Determine the percentage of antibiotic over-prescribing and under-prescribing by Veteran's race/ethnicity for urinary tract infections in VAST sites. Aim 3: Explore the system factors that predict the rate of over/under prescription of antibiotics by race/ethnicity. Methodology: For Aim 1, a retrospective cohort design will include outpatients from the 16 VAST study sites with a diagnosis of acute respiratory infection. The percentage of over-prescribing, and under-prescribing will be determined using criteria from clinical practice guidelines. Multinomial logistic regression models will determine the likelihood of patients correctly treated, over, or under-prescribed antibiotics by race/ethnicity. For Aim 2, a randomly selected sample of outpatients presenting with a urinary tract infection will be examined using electronic medical reviews to determine whether the diagnosis and treatment of urinary tract infection was appropriate according to clinical practice guidelines. The ratio of appropriately diagnosed and prescribed events will be evaluated by race/ethnicity. Aim 3 will use the same cohorts described in Aims 1 & 2 to determine the difference in antibiotic prescribing practices by system factors. Hierarchical logistic regression models will determine the likelihood of patients being over or under-prescribed antibiotics. Candidate Background: Dr. Wilson has been a Research Health Scientist with the Center of Innovation for Complex Chronic Healthcare (CINCCH) at Edward Hines Jr. VA Medical Center since August 2019. She has collaborated on several infection prevention projects in collaboration with the VA Multidrug Resistant Organisms (MDRO) program office, the VA Quality Enhancement Research Initiative (QUERI) program, and the VA National Center for Health Promotion (NCP). Her career goal is to become an independent health services researcher with expertise in evaluating and implementing infection prevention, antimicrobial and diagnostic stewardship interventions. Mentors. Mentorship Plan: Dr. Wilson's mentoring team consists of Dr. Charlesnika Evans, a VA Research Career Scientist with over 20 years' experience in infection control and stewardship research, Dr. Robin Jump, a VA Infectious Disease physician with expertise in antibiotic stewardship, and Dr. Karen Saban, a VA Research Health Scientist and nurse with a background in health disparities research. In addition to monthly meetings with her team, Dr. Wilson will participate in a health equity course series offered through Johns Hopkins as well as professional development seminars through the VA Office of Health Equity.

背景：抗菌素耐药性和医疗保健相关病原体在美国是一个严重的威胁 美国每年有300多万人感染。抗菌药物管理仍然是最强大的工具 在减少抗生素的过度处方方面，抗生素是导致耐药性的主要可改变原因。尽管如此， 不适当的抗生素使用在退伍军人管理局仍然很常见。此外，人们对健康的作用知之甚少 差异在抗生素不适当的抗生素处方中起到了作用。 意义：这项建议对退伍军人和退伍军人管理局的目标具有非常重要的意义。之前的研究已经 结果表明，退伍军人管理局门诊需要额外的抗菌药物管理工作。此外，这一点 该项目将提供关于健康差距和系统因素的证据，这些因素可以作为干预措施的目标 改进退伍军人事务部门诊抗生素处方。该项目与我们运营合作伙伴的优先事项保持一致： 退伍军人管理局抗菌素管理工作队和农村卫生办公室。 具体目标：这项提案的目标将是评估推动患者和系统因素 视频会议抗菌药物管理小组(Vavast)研究中不适当的抗生素处方 使用综合健康差距和抗微生物管理框架的网站。目标1：确定 因下列原因引起的急性呼吸道感染抗生素处方过多和处方不足的百分比 退伍军人的种族/民族在广阔的地点。目标2：确定抗生素过量处方的百分比和 退伍军人的种族/民族在大范围内对尿路感染开出的处方不足。目标3：探索 按种族/民族预测抗生素处方过量/不足的系统因素。 方法：对于目标1，将包括来自16个广泛研究地点的门诊患者的回溯性队列设计 被诊断为急性呼吸道感染。过量开药和开药不足的比例将 使用临床实践指南中的标准来确定。多项Logistic回归模型将 按种族/民族确定患者正确治疗、抗生素过量或处方不足的可能性。为 目的2，随机抽取门诊尿路感染患者样本进行检查。 利用电子医学评审确定尿路感染的诊断和治疗 根据临床实践指南是适当的。适当诊断和处方的比例 赛事将根据种族/民族进行评估。目标3将使用目标1和目标2中描述的相同队列来 根据系统因素确定抗生素处方实践的差异。分层Logistic回归 模型将确定患者抗生素处方过多或过少的可能性。 候选人背景：威尔逊博士一直是创新中心的研究健康科学家 小Edward Hines的复杂慢性医疗(CINCCH)弗吉尼亚医疗中心自2019年8月以来。她有 与退伍军人管理局多药耐药组织合作开展了几个感染预防项目 生物体(MDRO)计划办公室、退伍军人事务部质量增强研究倡议(QUERI)计划以及 退伍军人事务部国家健康促进中心(NCP)。她的职业目标是成为一名独立的健康人 具有评估和实施感染预防、抗菌剂和 诊断性管理干预。 导师。导师计划：威尔逊博士的导师团队由退伍军人事务部研究员查尔斯尼卡·埃文斯博士组成 拥有20多年感染控制和管理研究经验的职业科学家Robin Jump博士， 一位在抗生素管理方面有专长的退伍军人事务部传染病医生，以及退伍军人事务部的凯伦·萨班博士 研究具有健康差距研究背景的健康科学家和护士。除月刊外 与她的团队会面，威尔逊博士将参加约翰斯提供的健康公平课程系列 霍普金斯大学以及通过退伍军人事务部举办的职业发展研讨会。