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: 10312278
• 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/10312278
• 关键词: Acute; Address; Administrator; Affect; Antibiotic Therapy; Antibiotics; Antimicrobial Resistance; Area; COVID-19; Caring; Cellulitis; Cessation of life; Clinical; Clinical Nurse Specialists; Clinical Pharmacists; Clinical Practice Guideline; Clinical effectiveness; Collaborations; Communicable Diseases; Community Healthcare; Complex; Consultations; Data; Development; Dissemination and Implementation; Effectiveness; Evidence based intervention; Feedback; Goals; Guidelines; Health; 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; 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; Testing; Time; Training; United States Department of Veterans Affairs; Urinary tract infection; Veterans; Work; antimicrobial; base; care outcomes; care providers; clinical care; combat; design; effectiveness implementation design; effectiveness implementation study; 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

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：抗菌药物管理指南呼吁针对传染病建立多学科团队 （ID）医师和经过ID培训的临床药师作为核心成员，但遗憾的是，ID-的数量不足。 训练有素的专家在整个 VA 的现场抗菌管理项目中担任工作人员。 意义：该提案对于退伍军人来说非常重要，退伍军人事务部的目标也有很多意义。 与抗生素耐药性和医疗保健相关感染发生相关的危险因素。 2019 年新型冠状病毒病 (COVID-19) 对退伍军人健康产生前所未有的影响 在我们的整个医疗保健系统中，对 ID 专业知识的需求更加明显，尤其是在 此外，这项研究直接涉及 VA 使命法案，以改善获得护理的机会， 最后，该项目与远程医疗服务的优先事项保持一致。 我们的运营合作伙伴：退伍军人管理局抗菌药物管理工作组 (ASTF)、退伍军人管理局国家传染病 服务 (NIDS)、VA 药房福利管理 (PBM) 服务和农村卫生办公室。 创新和影响：设计是创新的，因为我们会系统地测试和评估 实施远程医疗以进行抗菌药物管理，这是一种尚未得到解决的新方法障碍 除我们之前的试点研究外，还在 VA 设施中实施了抗生素使用报告 (AUR)。 是同行比较的创新改编，是一种在门诊取得成功的抗生素管理策略 该项目将提供可在全国范围内部署的可扩展模型的研究结果。 适用的 VAMC，继续发挥 VHA 作为实施大规模干预措施的领导者的作用 关于身份识别的预防和管理以及管理。 具体目标：我们的目标是建立一个多学科视频会议抗菌管理团队 (VAST) 在 VAMC 中使用 SCAN-ECHO 我们的中心假设是反馈报告量化设施。 水平抗生素的使用将提高 VAST 的功效，以支持抗菌药物管理。 2 型混合有效性实施设计，比较实施该方案的场所的临床有效性 单独使用 VAST (VAST-) 到实施由设施级抗生素使用报告增强的 VAST 的场所 (VAST+) 目标是： 1) 确定并测试实施 VAST 的有效策略； VAST 总体和 VAST+ 对疑似感染退伍军人的护理的影响； VAST 总体和 VAST+ 对每个 VAMC 抗生素使用的影响。 方法：我们将随机抽取没有经过身份识别培训的专业人员的农村 VAMC 来实施 单独 VAST (VAST-) 与 VAST + 抗生素使用反馈 (VAST+) 目标 1：我们将评估修改。 干预地点和传染病专家的调整将包括过程。 地图和半结构化访谈，收集有关 VAST 关键成员看法的定性数据 我们还将评估目标 2 的实施成本。 我们将评估所服务的退伍军人群体、临床活动以及用户对 VAST 的看法。 评估临床护理与循证临床实践建议的一致性 将评估 VAST 会员对护理质量和及时性的看法。目标 3： 主要结果指标是抗生素的总体使用率，次要结果是抗生素使用率的变化。 广谱抗生素的使用率、抗生素的开始使用以及抗生素治疗的持续时间。 后续步骤/实施：在其他 VAMC 测试 VAST 的有效实施是一项重要任务 这是在急性和长期护理环境中加强抗菌药物管理的重要一步。 与 VA 临床运营合作伙伴合作，该试验的结果将用于推出 其他 VAMC 以及非 VA 设置使用的实施手册。