Guideline Implementation to Decrease Inappropriate Bacteriuria Treatment

减少不适当菌尿治疗的指南实施

基本信息

批准号：
8600170
负责人：
BARBARA Wells TRAUTNER
金额：
--
依托单位：
MICHAEL E DEBAKEY VA MEDICAL CENTER
依托单位国家：
美国
项目类别：
财政年份：
2010
资助国家：
美国
起止时间：
2010-04-01 至 2013-03-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8600170
关键词：
Acute Address Adherence Adverse effects Advisory Committees Americas Antibiotics Antimicrobial Resistance Attention Attitude Awareness Bacteremia Bacteriuria Belief Beryllium Blinded Caring Catheters Centers for Disease Control and Prevention (U.S.)Climate Clinical Clinical Practice Guideline Communicable Diseases Diagnosis Disease Education Effectiveness Elements Expectancy Familiarity Feedback Futility Goals Guideline Adherence Guidelines Health Personnel Healthcare Healthcare Systems Hospitals Human Resources Incidence Individual Infection Inpatients Institution Intervention Knowledge Lead Long-Term Care Measurable Measurement Measures Medical center Medicine Methods Monitor Multi-Drug Resistance Nosocomial Infections Outcome Patients Persons Population Study Practice Guidelines Prevention Preventive Process Provider Published Practice Guidelines Publishing Pyelonephritis Quality of Care Reporting Research Resistance Safety Services Site Societies South Texas Subacute Care Surveys System Telephone Treatment Cost Urinary tract infection Urine Veterans antimicrobial base catheter associated UTI clinical practice clinically significant cost cost effectiveness disorder prevention evidence base evidence based guidelines implementation research improved individualized feedback insight intervention effect nosocomial UTI pathogen pressure prevent screening urinary ward

项目摘要

Anticipated Impacts on Veterans' Healthcare: Urinary tract infection (UTI) is the single most common hospital-acquired infection. However, the majority of cases of nosocomial catheter- associated urinary tract infection (CAUTI) are really asymptomatic bacteriuria (ABU). ABU is not a clinically significant condition, and treatment is unlikely to confer benefit. Overtreatment of ABU is a quality, safety, and cost issue, particularly as unnecessary antibiotics lead to emergence of resistant flora. Our proposal to bring clinical practice in line with published guidelines has significant potential to decrease CAUTI and associated inappropriate antibiotic use in VA hospitals. Our study will also provide information about how to maximize effectiveness of audit- feedback to achieve guideline adherence in the inpatient VA setting. Project Background/Rationale: Evidence-based guidelines recommend that providers neither screen for nor treat ABU in most catheterized patients. However, a significant gap between these guidelines and clinical practice has been documented at our VA hospital and throughout the world. Since many VA patients in both acute care settings and sub-acute care settings, such as intermediate and long-term care, have a legitimate need for a urinary catheter, the issue of overtreatment of catheter-associated ABU is an active problem for the VA. Project Objectives: We hypothesize that implementing the existing evidence-based guidelines about non-treatment of ABU will dramatically reduce the unnecessary use of antibiotics to treat ABU and the incidence of incorrectly diagnosed CAUTI. Our first objective is to improve quality of care concerning ABU in terms of specific clinical outcomes (inappropriate screening for and treatment of ABU) through implementation of an audit-feedback strategy. We also hypothesize that successful implementation of an audit-feedback strategy will result in measurable changes in clinicians' knowledge and attitudes concerning ABU practice guidelines. Our second objective is to assess through surveys the effect of the implementation on clinicians' guideline awareness, familiarity, acceptance, and outcome expectancy. Project Methods: Our guidelines implementation strategy will employ audit-feedback, applied as a post-prescription antimicrobial review based on established guidelines. The study population for the clinical outcomes is all inpatients on certain wards at the intervention site (Houston VA) and the control site (San Antonio VA). Our study population for the audit-feedback intervention and surveys is the health care providers on these wards. We propose a 3-year study. During the first year we will observe the baseline incidence of inappropriate screening for and treatment of ABU at both sites. Blinded monitoring of clinical outcomes will continue during the next 2 years of the study. During the second year, we will distribute the guidelines at both sites. Clinicians at the intervention site will receive individualized feedback, either by telephone or in person, about whether their management of bacteriuria was guideline-compliant. Unit-level feedback will also be provided. During the third year, individualized feedback will cease, but unit-level feedback will continue as this constitutes a sustainable intervention. Clinicians will complete pre/post surveys of awareness, familiarity, acceptance, and outcome expectancy at the intervention site in year 2 and at both sites in year 3. Differences in outcomes between the individualized intervention in year 2 and the group-level intervention in year 3 will help to determine the necessary intensity of intervention for dissemination and implementation in other VA facilities.

对退伍军人医疗保健的预期影响：尿路感染（UTI）是最单一的常见医院获得的感染。但是，大多数医院导管的病例相关的尿路感染（CAUTI）确实是无症状的细菌（ABU）。阿布不是临床意义，治疗不太可能赋予益处。过度治疗阿布是质量，安全性和成本问题，特别是因为不必要的抗生素导致出现抗性菌群。我们将临床实践符合已发表指南的建议在VA中降低小肠和相关抗生素使用的巨大潜力医院。我们的研究还将提供有关如何最大化审计有效性的信息 - 反馈以在住院VA设置中实现指南遵守。项目背景/理由：基于证据的准则建议提供者既不在大多数导管插入的患者中筛选或治疗ABU。但是，这些差距很大指南和临床实践已在我们的弗吉尼亚州医院和整个过程中记录世界。由于许多在急性护理环境和亚急性护理环境中的VA患者，例如中级和长期护理，对尿导管有合法的需求与导管相关的ABU的过度治疗是VA的活跃问题。项目目标：我们假设实施现有的基于证据的准则关于阿布的不治疗将大大减少不必要的抗生素治疗 ABU和错误诊断的CAUTI的发生率。我们的第一个目标是提高质量在特定临床结果方面关心ABU（不适当的筛查和通过实施审计反馈策略来处理ABU）。我们也假设成功实施审计反馈策略将导致可衡量的变化临床医生关于ABU实践指南的知识和态度。我们的第二个目标是通过调查评估实施对临床医生指南意识的影响，熟悉，接受和预期。项目方法：我们的指南实施策略将采用审计反馈，应用于基于既定指南的处方后抗菌综述。研究人群临床结果是在干预地点（Houston VA）和控制地点（San Antonio VA）。我们的研究人群进行审计反馈干预和调查是这些病房的医疗保健提供者。我们提出了一项为期3年的研究。在第一个一年，我们将观察到ABU的不适当筛查和治疗的基线发病率在两个站点。在接下来的两年中，对临床结果的盲目监测将继续学习。在第二年，我们将在两个站点分发准则。临床医生干预网站将通过电话或亲自接收个性化反馈他们对细菌尿的管理是否符合准则。单位级反馈也将是假如。在第三年，个性化的反馈将停止，但单位级反馈将继续进行，因为这构成了可持续的干预。临床医生将完成前/后调查在第二年的干预网站和在第3年的两个地点。第三年的小组级干预将有助于确定必要的强度在其他VA设施中进行传播和实施的干预。