Optimizing Bacteriuria Management in Veterans with Spinal Cord Injury

候选人：Felicia Skelton博士在贝勒医学院(BCM)完成医学院学业，在 华盛顿大学康复医学，担任首席住院医师，并在 BCM的脊髓损伤(SCI)药物。她目前是卫生服务研发(HSR&D)博士后研究员 在Michael E.DeBakey VA的质量、效率和安全创新中心(Quest) 德克萨斯州休斯顿的医疗中心(MEDVAMC)。她有四份第一作者的出版物，其中一份已提交 手稿和两份悬而未决的手稿。她致力于临床科学家和黑人的职业生涯 女性，历史黑人学院或大学(HBCU)研究科学家培训的理想人选 程序。职业发展和目标：在此授勋期间，斯凯尔顿博士将获得必要的 流行病学、定性方法、数据库分析和实施科学技能 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提供和结果 SCI。这将通过完成课程完成，从而获得临床调查硕士学位。 以及她的不同导师和团队开发的其他有针对性的教育机会 顾问。环境：Quest和MEDVAMC是完成这项研究的理想环境，因为 西南部首屈一指的高铁中心，全国最大的SCI中心之一，为450多人提供服务 每年分别在门诊环境中的退伍军人。斯凯尔顿医生得到了临床、研究的支持， 这一项目在当地和全国的行政和患者倡导领导。研究： 菌尿、乙醚无症状(ASB)或症状性尿路感染(UTI)在脊髓损伤患者中很常见。 目前的退伍军人健康管理局(VHA)指南建议对每一位退伍军人进行尿液培养筛查 在年度评估中患有SCI的退伍军人，即使是有症状的，这与其他国家的情况相反 指导方针。我们的初步数据表明，尿液培养阳性(即使没有症状或体征) 感染)促使抗生素的使用。由于年度检查的临床结果尚未得到探索，我们 理论上，一些退伍军人正在接受不必要的抗生素治疗。抗生素的负面后果 过度使用和抗生素耐药性是有据可查的，并受到全国乃至全球的关注。本研究 将制定一项干预措施，旨在教育利益相关者关于ASB和UTI的循证管理， 并在这一高危人群中指导抗生素管理。目标1将确定患者、提供者和设施 在SCI年度评估后，细菌尿测试和随后的抗生素使用的驱动因素 定性访谈和定量调查。AIM 2将使用国家VHA数据库来确定预测因素 在年度检查期间的尿液检测和随后的抗生素使用情况，并比较临床 那些接受抗生素的人的结果是没有接受抗生素的人。目标3将使用从以下地点收集的信息 前者的目标是发展患者和提供者相结合的“智能检测、智能治疗”干预 教育和资源，将帮助所有利益攸关方就尿液检测和 抗生素的使用；可行性将在一个地点进行测试。下一步将是完善干预措施并测试其 多个地点的可行性和有效性，并提供退伍军人事务部功绩审查资金，并指导政策改革 围绕着这种常见但负担沉重的情况。

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.