Combating Antimicrobial Resistance through Rapid Implementation of Available Guidelines and Evidence (CARRIAGE)

通过快速实施现有指南和证据来对抗抗菌素耐药性 (CARRIAGE)

基本信息

批准号：
9205309
负责人：
CHARLESNIKA T EVANS
金额：
--
依托单位：
VA SALT LAKE CITY HEALTHCARE SYSTEM
依托单位国家：
美国
项目类别：
财政年份：
2016
资助国家：
美国
起止时间：
2016-10-01 至 2021-09-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9205309
关键词：
Acute Address Address Adherence Adherence Advisory Committees Advisory Committees Antibiotic Resistance Antibiotic Resistance Antibiotics Antibiotics Antimicrobial Resistance Antimicrobial Resistance Bacterial Antibiotic Resistance Behavior Behavior Caring Caring Cause of Death Cause of Death Centers for Disease Control and Prevention (U.S.)Centers for Disease Control and Prevention (U.S.)Clinical Clinical Clostridium difficile Clostridium difficile Collaborations Collaborations Combating Antibiotic Resistant Bacteria Combating Antibiotic Resistant Bacteria Communicable Diseases Communicable Diseases Data Data Data Collection Data Collection Data Set Data Set Development Development Education Education Engineering Engineering Evaluation Evaluation Event Event Evidence based practice Evidence based practice Feedback Feedback Focus Groups Focus Groups Fostering Fostering Future Future Goals Goals Government Agencies Government Agencies Guidelines Guidelines Handwashing Handwashing Health Health Health Care Costs Health Care Costs Health Services Health Services Health care facility Health care facility Healthcare Healthcare Systems Healthcare Systems Hospitals Hospitals Infection Infection Infection Control Infection Control Infection prevention Infection prevention Inpatients Inpatients Integrated Health Care Systems Intervention Intervention Interview Interview Investments Investments Lead Lead Learning Learning Life Life Mentors Mentors Methods Methods Mission Mission Modeling Modeling Occupational Health Occupational Health Patient Care Patient Care Policies Policies Practice Guidelines Practice Guidelines Prevention Prevention Process Process Provider Provider Public Health Public Health Quality of Care Quality of Care Records Records Research Research Research Design Research Design Resistance Resistance Safety Safety Scientist Scientist Series Series Services Services Strategic Planning Strategic Planning Surveys Surveys System System Time Time Translating Translating Veterans Veterans Work Work acute care antimicrobial antimicrobial bacterial resistance carbapenem-resistant Enterobacteriaceae carbapenem-resistant Enterobacteriaceae clinical decision support clinical practice clinical practice combat combat contextual factors contextual factors design design drug resistant pathogen health care delivery health care delivery health care quality health care quality health care service organization health care settings healthcare-associated infections implementation research implementation research implementation science implementation science implementation strategy improved improved innovation innovation interest interest multi-drug resistant pathogen multi-drug resistant pathogen novel novel pathogen pathogen patient oriented patient oriented patient safety patient safety prevent prevent programs programs prospective prospective repaired repaired routine care routine care theories theories transmission process transmission process uptake uptake

项目摘要

Background: Annually, at least two million illnesses and 23,000 deaths are caused by antibiotic-resistant bacteria in the US alone, with an annual impact of $20-35 billion in excess health care costs. The emergence of antibiotic resistance means the treatment of infections is becoming increasingly difficult, expensive, and, in some cases, nonexistent. Judicious use of antibiotics is essential to slow the emergence of resistance and extend the useful life of effective antibiotics, but prevention of resistance also requires efforts to control pathogen transmission across healthcare settings and reduce healthcare-associated infections. VA is not immune to this rising threat to patient safety, but our national, integrated healthcare system for Veterans offers unique opportunities to significantly alter the course of events and improve the outlook for our future through novel implementation and quality improvement efforts. Objectives: The goal of this QUERI program is to address the growing concern of antimicrobial resistance through strategies targeting improved use of antibiotics and prevention of healthcare-associated infections (HAI) across VA patient care settings. In doing so, we will address the priority goals of our VA operational partners, the QUERI Strategic Plans, the 2014 VHA Blueprint for Excellence, and the goals of the National Action Plan for Combating Antibiotic-resistant Bacteria as put forth by President Obama. Our specific objectives are to (a) promote judicious inpatient antibiotic use through a novel antibiotic self-stewardship "timeout" project that prompts VA providers to evaluate the continued need for antibiotics; (b) support and enhance the implementation of new VA guidelines to detect and prevent the spread of carbapenem-resistant Enterobacteriaceae in VA hospitals; (c) foster improved handwashing practice by repairing the broken audit- and-feedback mechanism in VA acute-care hospitals via a VISN-wide quality improvement project; and (d) evaluate and enhance the implementation of the national C. difficile bundle at VA acute-care facilities; Methods: Program projects will vary in study timeframe and start date over the five-year QUERI program timeframe. Research designs utilized across projects will include the experimental stepped wedge design for implementation of interventions, prospective observational designs of practice implementation of large-scale policy initiatives, and rigorous evaluation of VA national policies. The program will employ complementary implementation strategies and theories guided by an Implementation Core consisting of a team of notable VA implementation scientists with proven track records in designing and executing programs to control antimicrobial resistance and HAIs. Specific implementation strategies will include audit and feedback, clinical decision support, external facilitation, provider education and activation, and adherence engineering. The Promoting Action on Research in Health Services (PARiHS) framework will be used to assess contextual factors influencing implementation within facilities, while work system barriers and facilitators will be assessed using the Consolidated Framework for Implementation Research (CFIR) and the Systems Engineering Initiative for Patient Safety (SEIPS) model. Data collection methods will include the use of national VA datasets, direct observation, and primary data (i.e., surveys, interviews, and focus groups).

背景：每年至少有200万种疾病和23,000人死亡是由抗生素耐药引起的仅在美国，细菌的年度影响为20-3.5亿美元，超额医疗保健费用。出现抗生素耐药性意味着感染的治疗变得越来越困难，昂贵，并且有些情况，不存在。明智地使用抗生素对于减缓抗药性的出现至关重要延长有效抗生素的有用寿命，但预防抵抗也需要努力控制跨医疗机构的病原体传播并减少与医疗保健相关的感染。 VA不是免疫这种对患者安全的威胁不断增加，但我们为退伍军人提供的国家，综合医疗系统独特的机会，可以显着改变事件的过程，并通过新颖的实施和质量改进工作。目的：此Queri计划的目标是解决抗菌抗性日益关注的关注点通过针对改善抗生素使用并预防医疗保健相关感染的策略（HAI）在VA患者护理环境中。通过这样做，我们将解决VA运营的优先目标合作伙伴，Queri战略计划，2014年VHA蓝图的卓越蓝图以及国家的目标如奥巴马总统所提出的那样，针对抗生素耐药细菌的行动计划。我们的具体目的是通过新颖的抗生素自我服务来促进明智的住院抗生素使用 “超时”项目促使VA提供商评估持续的抗生素需求；（b）支持和增强实施新的VA指南，以检测和防止抗碳青霉烯的传播 VA医院的肠杆菌科；（c）通过修复破损的审核来促进改进洗手练习 - VA急性医院的反馈机制通过VISN范围的质量改进项目；（d）评估并增强在VA急诊设施中的国家艰难梭菌束的实施；方法：计划项目的学习时间范围会有所不同，并在五年QUERI计划中开始日期大体时间。跨项目使用的研究设计将包括用于实验性的梯形楔形设计实施干预措施，实践实施大规模实施的前瞻性观察设计政策举措，以及对VA国家政策的严格评估。该计划将采用补充实施策略和理论以实施核心为指导，由著名VA团队组成实施科学家在设计和执行程序中具有可靠的记录记录以控制抗菌素耐药性和HAI。具体的实施策略将包括审核和反馈，临床决策支持，外部促进，提供者的教育和激活以及依从性工程。这促进对卫生服务研究（PARIHS）框架的行动将用于评估上下文影响设施内实施的因素，同时将评估工作系统障碍和促进者使用合并框架进行实施研究（CFIR）和系统工程患者安全倡议（SEIP）模型。数据收集方法将包括使用国家VA数据集，直接观察和主要数据（即调查，访谈和焦点小组）。