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：耐药性和卫生保健相关病原体是美国的一个严重威胁。 每年有超过300万人感染。抗菌药物管理仍然是最有力的工具 减少抗生素的过度处方，抗生素是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。 在抗生素不适当的抗生素处方中存在差异。 意义：这项建议对退伍军人和退伍军人事务部的目标具有重要意义。先前的研究 表明在VA门诊环境中需要额外的抗菌药物管理工作。而且这个 该项目将提供有关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， 改善VA门诊抗生素处方。该项目与我们的运营合作伙伴的优先事项保持一致： VA抗菌药物管理工作组和农村卫生办公室。 具体目标：本提案的目标是评估患者和系统因素， 视频会议抗菌药物管理小组（VAST）研究中的抗生素处方不当 使用综合健康差异和抗菌管理框架的地点。目标1：确定 发生的急性呼吸道感染抗生素处方过量和处方不足的百分比 VAST研究中心的退伍军人人种/种族。目标2：确定抗生素过量处方的百分比， 在VAST研究中心，根据退伍军人种族/种族对尿路感染开药不足。目标3：探索 根据人种/种族预测抗生素处方过量/不足率的系统因素。 方法学：对于目标1，回顾性队列设计将包括来自16个VAST研究中心的门诊患者 被诊断为急性呼吸道感染过度处方和处方不足的百分比将 使用临床实践指南中的标准确定。多项logistic回归模型将 根据人种/种族确定患者正确治疗、抗生素处方过量或不足的可能性。为 目的2，随机选择的样本门诊病人提出的尿路感染将进行检查 使用电子医疗评论，以确定是否诊断和治疗尿路感染 根据临床实践指南是适当的。适当诊断和处方的比例 将按人种/种族评价事件。目标3将使用目标1和目标2所述的相同群组， 通过系统因素确定抗生素处方实践的差异。分层逻辑回归 模型将确定患者过量或不足处方抗生素的可能性。 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， 复杂的慢性医疗保健（CINCCH）在爱德华海因斯小。VA医疗中心自2019年8月以来。她有 与VA多药耐药合作开展了几个感染预防项目 生物（MDRO）计划办公室，VA质量增强研究计划（QUERI）计划，以及 VA国家健康促进中心（NCP）。她的职业目标是成为一名独立健康的 服务研究员，在评估和实施感染预防，抗菌和 诊断性管理干预。 导师导师计划：威尔逊博士的导师团队由弗吉尼亚州研究中心的Charlesnika Evans博士组成。 Robin Jump博士是一位在感染控制和管理研究方面拥有20多年经验的职业科学家， 一位在抗生素管理方面具有专业知识的VA传染病医生，和一位VA 研究健康科学家和护士，具有健康差异研究背景。除了每月 与她的团队会议，威尔逊博士将参加通过约翰提供的健康公平课程系列 霍普金斯以及通过退伍军人事务部健康公平办公室的专业发展研讨会。