Promoting De-Implementation of Inappropriate Antimicrobial Use in Cardiac Device Procedures By Expanding Audit and Feedback

通过扩大审计和反馈,促进消除心脏装置手术中不当使用抗菌药物的情况

基本信息

  • 批准号:
    10067042
  • 负责人:
  • 金额:
    --
  • 依托单位:
  • 依托单位国家:
    美国
  • 项目类别:
  • 财政年份:
    2021
  • 资助国家:
    美国
  • 起止时间:
    2021-05-01 至 2025-04-30
  • 项目状态:
    未结题

项目摘要

Background: Cardiac device procedures, such as pacemaker and defibrillator placements, are common and increasing as the population ages. These devices are life-saving for the Veterans who need them, but the pro- cedures can be complicated by highly morbid infections and other adverse events, resulting in poor outcomes. Clinical guidelines recommend administration of pre-procedural antimicrobials to prevent cardiac device infec- tions and early discontinuation of antimicrobials after the procedure to prevent harms caused by unnecessary antimicrobial use, such as kidney injury, C. difficile infections, and antimicrobial resistance. However, these guidelines are rarely applied, resulting in preventable morbidity and mortality, and creating a critical need for research investigating strategies to promote adoption of best practices (e.g., learning) and de-adoption of inef- fective and harmful practices (e.g., unlearning). Significance/Impact: The research in this study closes an important gap in the care of cardiac device recipients and advances several VA HSR&D research priorities, including implementation, informatics, and quality of care. It leverages the strength of the VA electronic health record (EHR) and will provide important insights into clinical informatics methodologies for expanding surveillance of healthcare-associated infections and antimicrobial use to include outpatient and procedural areas. Investigators will also promote understanding about how learning and unlearning processes can be leveraged to enhance adoption of clinical guidelines and de-implementation of ineffective and harmful practices. Innovation: The highly innovative, informatics-based audit and feedback system will advance the field of imple- mentation science by yielding a new strategy for promoting de-implementation of inappropriate practices. Les- sons learned about how to implement novel, real-time informatics tools and adapt and scale them will also be generalizable to procedural areas with limited resources to support surveillance. Aim I: Tests the hypothesis that a multi-faceted implementation strategy including automated audit and feed- back, education of electrophysiology team members, local adaptation, and blended facilitation with engagement of local champions, will improve adoption of antimicrobial prophylaxis guidelines for electrophysiology proce- dures at three VA facilities, using a stepped-wedge, Hybrid III design. Primary outcome is adoption of guideline- recommended antimicrobial use. Clinical effectiveness will be assessed through measurement of clinical out- comes (CIED infections, AKI, and C. difficile). Aim II: Measures the feasibility of using an informatics-based algorithm to measure outcomes and guideline- concordance following cardiac device procedures at 78 facilities and tests the passive diffusion of reports. Methodology: There is a major gap in studies evaluating de-implementation of ineffective practices. This study has two complimentary aims and will address this gap by testing the utility of a highly innovative clinical infor- matics tool developed using the robust VA EHR. The informatics tool combines feedback about best practices and positive clinical outcomes (learning) with feedback about ineffective and harmful practices and adverse clin- ical outcomes (unlearning) as part of a multi-faceted implementation strategy. Aim I will test the multi-faceted implementation strategy at three VAs using a Hybrid III design. Aim II will test the tool’s scalability and dissemi- nation throughout the VA and will identify barriers to expansion and potential solutions. Implementation/Next Steps: The central aim of this study is to implement ways to promote best practices. Tools developed during the course of the study will be widely disseminated throughout the VA to enhance the quality of care and will be provided to key operational partners, who can adapt the clinical informatics tools to promote best practices in other clinical cares with limited infection prevention and stewardship resources.
背景:心脏装置手术,如起搏器和除颤器的放置,是常见的和 随着人口老龄化而增加。这些设备对于需要它们的退伍军人来说是救命的,但专业- 高度病态感染和其他不良事件可能使死亡复杂化,导致不良结局。 临床指南建议术前给予抗菌药,以预防心脏装置感染。 术后及早停用抗菌药物以防止不必要的伤害 抗菌药物的使用,如肾脏损伤、艰难梭菌感染和抗菌素耐药性。然而,这些 指南很少应用,导致了可预防的发病率和死亡率,并产生了对 调查促进采用最佳做法(例如,学习)和不采用INF的战略的研究 影响和有害的做法(例如,遗忘)。 意义/影响:这项研究填补了心脏装置接受者护理方面的一个重要空白 并提出了几个退伍军人事务部HSR&D研究的优先事项,包括实施、信息学和护理质量。 它利用退伍军人管理局电子健康记录(EHR)的优势,将为临床提供重要的见解 扩大医疗保健相关感染和抗菌药物使用监测的信息学方法 包括门诊区和程序区。调查人员还将促进对如何学习的理解 可以利用遗忘过程来促进临床指南的采用和取消实施 无效和有害的做法。 创新:高度创新的信息化审计和反馈系统将推动实施- 通过制定一项新的战略来促进不适当做法的去实施,从而促进心理科学。莱斯- Sons还将学习如何实施新颖的实时信息学工具,并对其进行调整和扩展 可推广到资源有限的程序性领域,以支持监督。 目标一:测试包括自动审计和馈送在内的多方面实施战略的假设- BACK,电生理团队成员的教育,局部适应,以及将促进与参与相结合 将促进电生理过程中抗菌素预防指南的采用- 在三个退伍军人管理局,使用阶梯楔形,混合III设计。主要成果是通过了指导方针- 推荐使用抗菌药物。将通过测量临床出院时间来评估临床效果。 来了(CIED感染、AKI和艰难梭菌)。 目标二:衡量使用基于信息学的算法来衡量结果和指导方针的可行性 在78个机构进行心脏装置手术后的一致性,并测试报告的被动扩散。 方法:在评估无效做法的取消实施的研究方面存在重大差距。本研究 有两个相辅相成的目标,并将通过测试高度创新的临床信息的效用来解决这一差距- 使用稳健的VA EHR开发的Matics工具。信息学工具结合了有关最佳实践的反馈 和积极的临床结果(学习),以及关于无效和有害做法和不良临床的反馈- 作为多方面实施战略的一部分,其成果(忘却)。Aim我将测试多方面的 使用混合III设计的三个虚拟助理的实施战略。AIM II将测试该工具的可扩展性和传播性- 我们将在退伍军人管理局的全国范围内开展业务,并将确定扩张的障碍和潜在的解决方案。 实施/下一步:这项研究的中心目标是落实促进最佳做法的方法。工具 在研究过程中制定的将在退伍军人事务部广泛传播,以提高质量 并将提供给主要的运营合作伙伴,他们可以调整临床信息学工具来促进 在感染预防和管理资源有限的其他临床护理方面的最佳做法。

项目成果

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Westyn Branch-Elliman其他文献

Westyn Branch-Elliman的其他文献

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{{ truncateString('Westyn Branch-Elliman', 18)}}的其他基金

Promoting De-Implementation of Inappropriate Antimicrobial Use in Cardiac Device Procedures By Expanding Audit and Feedback
通过扩大审计和反馈,促进消除心脏装置手术中不当使用抗菌药物的情况
  • 批准号:
    10404914
  • 财政年份:
    2021
  • 资助金额:
    --
  • 项目类别:
Promoting De-Implementation of Inappropriate Antimicrobial Use in Cardiac Device Procedures By Expanding Audit and Feedback
通过扩大审计和反馈,促进消除心脏装置手术中不当使用抗菌药物的情况
  • 批准号:
    10641761
  • 财政年份:
    2021
  • 资助金额:
    --
  • 项目类别:
Assessing the Sustainability of Compliance with Surgical Site Infection Prophylaxis After Discontinuation of Mandatory Active Reporting
评估停止强制主动报告后遵守手术部位感染预防措施的可持续性
  • 批准号:
    10494063
  • 财政年份:
    2021
  • 资助金额:
    --
  • 项目类别:
Enhancing the Care Continuum for Veterans Who Inject Drugs Using Harm Reduction Approaches
使用减少危害的方法加强对注射毒品退伍军人的连续护理
  • 批准号:
    10237183
  • 财政年份:
    2020
  • 资助金额:
    --
  • 项目类别:
Enhancing the Care Continuum for Veterans Who Inject Drugs Using Harm Reduction Approaches
使用减少危害的方法加强对注射毒品退伍军人的连续护理
  • 批准号:
    10065814
  • 财政年份:
    2020
  • 资助金额:
    --
  • 项目类别:
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