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: 10620614
• 负责人: CHARLESNIKA T EVANS
• 金额: --
• 依托单位: LOUIS STOKES CLEVELAND VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-05-01 至 2026-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10620614
• 关键词: Acute; Address; Administrator; Advisory Committees; Affect; Antibiotic Therapy; Antibiotics; Antimicrobial Resistance; Area; COVID-19; Caring; Cellulitis; Cessation of life; Clinical; Clinical Pharmacists; Clinical Practice Guideline; Clinical effectiveness; Collaborations; Communicable Diseases; Community Healthcare; Complex; Consultations; Cost Analysis; Data; Development; Dissemination and Implementation; Effectiveness; Evidence based intervention; Feedback; Goals; Guidelines; Health; Health Services; Health Services Accessibility; Healthcare; Healthcare Systems; Improve Access; Individual; Infection; Infection Control; Intervention; Interview; Length; Long-Term Care; Maps; Measures; Medical center; Mentors; Methodology; Methods; Modeling; Modification; Nurses; Outcome; Outcome Measure; Outpatients; Participant; Patient Care; Perception; Pharmacists; Physicians; Pilot Projects; Pneumonia; Policy Maker; Prevention; Process; Provider; Quality of Care; Randomized; Recommendation; Reporting; Resources; Risk Factors; Role; Rural; Rural Health; Services; Site; Specialist; Structure; System; Teleconferences; Testing; Training; United States Department of Veterans Affairs; Urinary tract infection; Veterans; Work; antimicrobial; care outcomes; care providers; clinical care; combat; design; effectiveness/implementation design; evidence base; evidence based guidelines; experience; feasibility testing; geographically distant; global health; healthcare-associated infections; implementation barriers; implementation cost; implementation evaluation; improved; innovation; interest; medical specialties; member; military veteran; multidisciplinary; novel coronavirus; novel strategies; operation; pathogen; patient safety; patient subsets; peer; pharmacy benefit; prevent; primary outcome; programs; secondary outcome; telehealth; videoconference

Background: Antimicrobial stewardship guidelines call for a multidisciplinary team with an infectious disease (ID) physician and ID-trained clinical pharmacist as core members. Unfortunately, there are insufficient ID- trained specialists to staff on-site antimicrobial stewardship programs throughout VA. Significance: This proposal is highly significant for Veterans and the goals of VA. Veterans experience many of the risk factors associated with development of antimicrobial resistant and healthcare-associated infections. The unprecedented effects of the novel Coronavirus disease 2019 (COVID-19) on the health of our Veterans and on our entire healthcare system makes the demand for ID expertise even more apparent, especially in long-term care. Also, this study directly addresses the VA MISSION ACT to improve access to care, timeliness and quality of care, using telehealth services. Finally, this project is aligned with the priorities of our operation partners: VA Antimicrobial Stewardship Taskforce (ASTF), the VA National Infectious Disease Service (NIDS), VA Pharmacy Benefits Management (PBM) Services, and the Office of Rural Health. Innovation and Impact: The design is innovative because we will systematically test and assess implementation barriers to telehealth for antimicrobial stewardship, a novel approach that has not been implemented in VA facilities, other than in our previous pilot study. Further, the Antibiotic Use Reports (AURs) are an innovative adaptation of peer-comparison, an antibiotic stewardship strategy successful in outpatient settings. This project will provide findings for a scalable model that could be deployed nationally to all applicable VAMCs, continuing the role of VHA as a leader in implementing large-scale interventions focused on prevention and management of ID and stewardship. Specific Aims: Our goal is to implement a multidisciplinary videoconference antimicrobial stewardship team (VAST) in VAMCs using SCAN-ECHO. Our central hypothesis is that feedback reports that quantify facility- level antibiotic use will enhance the efficacy of VASTs to support antimicrobial stewardship. We propose a Type 2 hybrid effectiveness-implementation design, comparing clinical effectiveness in sites that implement the VAST alone (VAST-) to sites that implement the VAST augmented by facility-level Antibiotic Use Reports (VAST+). Aims are: 1) Identify and test effective strategies for implementing the VAST; 2) Determine the influence of the VAST overall and VAST+ on the care of Veterans with suspected infections; 3) Determine the influence of the VAST overall and VAST+ on antibiotic use at each VAMC. Methodology: We will randomize rural VAMCs that do not have ID-trained professionals on staff to implement the VAST alone (VAST-) versus VAST + antibiotic use feedback (VAST+). Aim 1: We will assess modification and adaptations at the intervention sites and by the infectious disease experts. Methods will include process maps and semi-structured interviews to gather qualitative data about what key VAST members perceive as facilitators, barriers and burden to VAST implementation. We will also evaluate costs of implementation. Aim 2: We will evaluate the Veteran population served, clinical activities, and user perceptions of the VAST. We will assess the concordance of clinical care with recommendations from evidence-based clinical practice guidelines. VAST members’ perceptions of the quality and timeliness of care will be evaluated. Aim 3: The primary outcome measure will be overall rates of antibiotic use. Secondary outcomes will be changes in the rates of broad-spectrum antibiotic use, antibiotic starts, and length of antibiotic therapy. Next steps/Implementation: Testing effective implementation of the VAST at additional VAMCs is an important step toward augmenting antimicrobial stewardship in both acute- and long-term care settings. In collaboration with VA clinical operation partners, outcomes from this trial will be used to roll-out an implementation playbook to be used by other VAMCs, as well as non-VA settings.

背景：抗微生物药物管理指南要求有传染病的多学科团队