Optimizing Bacteriuria Management in Veterans with Spinal Cord Injury

候选人：费利西亚·卡顿博士在贝勒医学院（Baylor College of Medicine，简称BLM）完成了医学院的学业， 康复医学在华盛顿大学，担任总住院医师，和临床奖学金， 脊髓损伤（SCI）的治疗她目前是健康服务研发（HSR&D）博士后研究员 质量、有效性和安全创新中心（Center for Innovations in Quality，Effectiveness and Safety，IQuESt）德贝基弗吉尼亚州 医疗中心（MEDVAMC），位于德克萨斯州休斯顿。她有四个第一作者的出版物，一个提交 手稿和两个悬而未决的手稿。她致力于临床科学家的职业生涯，作为一个黑人， 女性，历史上黑人学院或大学（HBCU）研究科学家培训的理想候选人 程序.职业发展和目标：在此奖励期间，Dr. 流行病学，定性方法，数据库分析和实施科学技能，成为一个 独立资助的临床医生科学家，为退伍军人探索最佳的医疗保健服务和结果， SCI.这将通过完成课程，导致从临床研究硕士学位， 以及她的不同导师小组开发的其他有针对性的教育机会， 顾问。环境：IQuESt和MEDVAMC是完成本研究的理想环境，因为 西南部的首要HSR中心和全国最大的SCI中心之一，为450多个 退伍军人在门诊设置每年，分别。克莱顿博士得到了临床研究的支持， 在当地和全国范围内为该项目提供行政和患者宣传领导。调研： 细菌尿、无症状性尿失禁或有症状的尿路感染在SCI患者中很常见. 目前退伍军人健康管理局（VHA）的指南建议，每一个筛查尿培养， 在年度评估期间患有SCI的退伍军人，即使有症状，这与其他国家相反。 指南我们的初步数据表明，阳性尿培养（即使没有迹象或症状， 感染）驱动抗生素的使用。由于尚未探索年度检查测试的临床结果，我们 理论上说，一些退伍军人正在接受不必要的抗生素。抗生素的负面影响 过度使用和抗生素耐药性是有据可查的，并已成为国家甚至全球关注的焦点。本研究 将制定一项干预措施，旨在教育利益相关者对ASB和UTI进行循证管理， 并指导高危人群的抗生素管理。目标1将确定患者、提供者和机构 SCI年度评估后驱动菌尿检测和随后抗生素使用的因素， 定性访谈和定量调查。目标2将使用国家VHA数据库来确定预测因素 尿液检测和随后的抗生素使用在年度检查，并比较临床 接受抗生素治疗的人与未接受抗生素治疗的人的结果。Aim 3将使用从 前一个目标是开发“智能测试，智能治疗”干预，患者和提供者的组合 教育和资源，这将有助于所有利益相关者有知情的谈话有关尿检， 抗生素的使用;将在一个地点测试可行性。下一步将是完善干预措施并测试其 在多个地点的可行性和有效性，与VA价值审查资金，以及指导政策改革 围绕这种常见但负担沉重的疾病。

Candidate: Dr. Felicia Skelton completed medical school at Baylor College of Medicine (BCM), residency in rehabilitation medicine at the University of Washington, serving as chief resident, and clinical fellowship in spinal cord injury (SCI) medicine at BCM. She is a current health services R&D (HSR&D) post-doctoral fellow at the Center for Innovations in Quality, Effectiveness and Safety (IQuESt) at the Michael E. DeBakey VA Medical Center (MEDVAMC) in Houston, TX. She has four first-authored publications, one submitted manuscript and two pending manuscripts. She is dedicated to a career as a clinician scientist, and as a Black female, an ideal candidate for the Historically Black College or University (HBCU) Research Scientist Training Program. Career Development and Goals: During this award period Dr. Skelton will obtain the necessary epidemiologic, qualitative methods, database analysis and implementation science skills to become an independently-funded clinician scientist exploring optimal health care delivery and outcomes for Veterans with SCI. This will be achieved through completion of coursework leading to a masters in clinical investigation from BCM, as well as other targeted educational opportunities developed by her diverse group of mentors and advisors. Environment: IQuESt and MEDVAMC are the ideal settings to complete this research, as the premiere HSR center in the Southwest and the one of the largest SCI centers in the nation, serving over 450 Veterans in the outpatient setting annually, respectively. Dr. Skelton has the support of clinical, research, administrative and patient advocacy leadership both locally and nationally for this project. Research: Bacteriuria, ether asymptomatic (ASB) or symptomatic urinary tract infection (UTI) is common in persons SCI. Current Veterans Health Administration (VHA) guidelines recommend a screening urine culture for every Veteran with SCI during their annual evaluation, even when symptomatic, which is contrary to other national guidelines. Our preliminary data suggest that a positive urine culture (even without signs or symptoms of infection) drives antibiotic use. As the clinical outcomes of the annual exam testing have not been explored, we theorize some Veterans are receiving antibiotics unnecessarily. The negative consequences of antibiotic overuse and antibiotic resistance are well documented, and have a national and even global focus. This study will develop an intervention aimed to educate stakeholders on evidence-based management of ASB and UTI, and guide antibiotic stewardship in this high-risk population. Aim 1 will identify patient, provider, and facility factors driving bacteriuria testing and subsequent antibiotic use after the SCI annual evaluation using qualitative interviews and quantitative surveys. Aim 2 will use national VHA databases to identify the predictors of urine testing and subsequent antibiotic use during the annual examination, and compare the clinical outcomes of those who received antibiotics to those who did not. Aim 3 will use the information gathered from the previous aims to develop the “Test Smart, Treat Smart” intervention, a combination of patient and provider education and resources that will help all stakeholders have informed conversations about urine testing and antibiotic use; feasibility will be tested at a single site. The next step wil be to refine the intervention and test its feasibility and effectiveness at multiple sites, with VA merit review funding, as well as guiding policy reform surrounding this common, but burdensome condition.