Optimizing Management of Urinary Tract Infections in Patients with Neurogenic Bladder through Improved Knowledge of Provider Practice and Patient-reported Outcomes

通过提高对医疗服务提供者实践和患者报告结果的了解，优化神经源性膀胱患者尿路感染的管理

• 批准号: 10652725
• 负责人: Margaret A Fitzpatrick
• 金额: --
• 依托单位: VA EASTERN COLORADO HEALTH CARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-01-01 至 2024-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10652725
• 关键词: Address; Adherence; Adverse effects; Affect; Anatomy; Antibiotic Resistance; Antibiotic Therapy; Antibiotics; Attitude; Bacteria; Bacteriuria; Belief; Bladder; Bladder Dysfunction; Caring; Catheters; Cessation of life; Characteristics; Chronic; Clinical; Clinical Treatment; Clostridium difficile; Communicable Diseases; Complex; Data; Development; Diagnosis; Diarrhea; Disease Management; Drainage procedure; Effectiveness of Interventions; Electronic Health Record; Ensure; Esthesia; Foundations; Future; Geographic Locations; Goals; Guidelines; Health; Hospitals; Impairment; Increased frequency of micturition; Infection; Intervention; Kidney Calculi; Knowledge; Laboratories; Lead; Measures; Methods; Multiple Bacterial Drug Resistance; Multiple Sclerosis; Nervous System Trauma; Neurogenic Bladder; Outcome; Outcome Measure; Parkinson Disease; Patient Care; Patient Education; Patient Outcomes Assessments; Patients; Persons; Population; Provider; Pyelonephritis; Qualitative Methods; Quality of life; Rehabilitation Outcome; Rehabilitation therapy; Reporting; Research; Research Personnel; Retrospective cohort study; Risk; Sepsis; Services; Shapes; Signs and Symptoms; Spinal Dysraphism; Spinal cord injury; Stroke; Surveys; Symptoms; Testing; Urinary tract; Urinary tract infection; Validation; Variant; Veterans; adverse drug reaction; adverse outcome; career; catalyst; chronic neurologic disease; clinical decision support; clinical outcome measures; cohort; computable phenotypes; disability; evidence base; evidence based guidelines; expectation; experience; high risk; improved; improved functioning; infection management; innovation; instrument; kidney dysfunction; medical specialties; military veteran; mortality; multi-drug resistant pathogen; multimodality; nervous system disorder; novel; patient expectation; patient oriented; patient population; patient subsets; patient-clinician communication; prevent; provider adherence; provider factors; side effect; successful intervention; treatment guidelines; urinary

Project Summary/Abstract Chronic neurologic injuries and diseases such as spinal cord injury (SCI), multiple sclerosis (MS), and Parkinson's disease (PD) often cause chronic bladder dysfunction termed `neurogenic bladder' (NB). Over 400,000 people are estimated to be living with NB in the U.S. The VA provides a significant amount of services for these patient populations, due to its unique focus on coordinated, lifelong care for Veterans with complex, chronic disabling conditions. Urinary tract infections (UTIs) are common complications in patients with NB and can cause pyelonephritis, sepsis, kidney stones, and, rarely, death. UTI management is challenging because bacteria frequently colonize a neurogenic bladder without infection, a situation called “asymptomatic bacteriuria” (ASB). Furthermore, UTI symptoms are often atypical in patients with NB due to impaired bladder sensation. Antibiotic treatment of UTIs is critical, however routine treatment of ASB is not beneficial and may lead to harm. Despite this, many patients with NB due to SCI, MS, and PD are managed improperly with high rates of unnecessary and/or inappropriate antibiotic use. [Improper UTI management directly impacts patient rehabilitative health, functioning, and quality of life via the long-term and profound adverse consequences of antibiotic resistance and antibiotic overuse.] However, the association of UTI management with patient- reported rehabilitation outcomes has not been well-studied or clearly delineated. Support from the CDA2 will provide Dr. Fitzpatrick with the necessary foundation for a successful career as a VA [rehabilitation researcher focused on implementing interventions to improve Veteran rehabilitative health by optimizing infectious diseases management and antibiotic use in patients with NB due to complex, chronic neurologic injuries and diseases.] Appropriate UTI management and avoidance of unnecessary antibiotics is critical to ensure the delivery of high quality, safe care for these high-priority patients. This innovative project will study a cohort of patients with NB [due to SCI, MS, and PD] cared for at a range of VA hospitals of varying geographic locations and sizes. It aims to characterize variations in care provided for ASB and UTI and associate them with key provider and patient characteristics using a retrospective cohort study with electronic health record data. It further aims to use qualitative methods to assess patient knowledge, attitudes, beliefs, and expectations regarding ASB and UTI and measure UTI-related patient-reported rehabilitation outcomes. In this way, the project represents a critical step forward in developing a patient-centered approach to ASB and UTI management. Results from this project will be used to support Dr. Fitzpatrick's VA Merit Review application to develop a multimodal patient-centered intervention to [improve functional and patient-reported rehabilitation outcomes via improved ASB and UTI management in patients with NB.] The specific components of the intervention will be informed by data acquired in this project and targeted to key patients and care settings associated with high rates of inappropriate management. Results from this study will also inform future efforts to use electronic health record data to [develop computable phenotypes for ASB and UTI in patients with NB] which will aid future research and quality improvement projects related to improved ASB and UTI management. Therefore, completion of this CDA2 project is expected to provide the critical groundwork leading to successful interventions for ASB and UTI management that improve health, functioning, and quality of life of for Veterans with NB due to chronic neurologic injuries and diseases.

项目摘要/摘要 慢性神经系统损伤和脊髓损伤（SCI），多发性硬化症（MS）和疾病 帕金森氏病（PD）通常会导致慢性膀胱功能障碍称为“神经源性膀胱”（NB）。超过 据估计，有40万人在美国与NB一起生活，弗吉尼亚州提供大量服务 对于这些患者人群，由于其独特的重点是协调的，终身照顾的，对具有复杂性的退伍军人 慢性禁用条件。尿路感染（UTI）是NB患者的常见并发症 会导致肾上腺炎，败血症，肾结石以及很少死亡。 UTI管理具有挑战性，因为 细菌经常在没有感染的情况下将神经源性膀胱殖民，这种情况称为“无症状 杆菌”（ASB）。此外，由于膀胱损伤，NB患者的UTI符号通常是非典型的 感觉。 UTI的抗生素治疗至关重要，但是ASB的常规处理无益，可能 导致伤害。尽管如此，许多由于SCI，MS和PD引起的NB患者的管理不当 不必要和/或不适当的抗生素使用率。 [不正确的UTI管理直接影响患者 康复健康，运作和生活质量通过长期和深刻的不利后果 ]但是，UTI管理与患者的关联 - 据报道，康复结果尚未得到充分研究或明确描述。 CDA2的支持将为Fitzpatrick博士提供成功的基础 VA [康复研究人员致力于实施干预措施以改善退伍军人康复健康 通过优化NB患者的传染病管理和抗生素使用，这是由于复杂的，慢性的 神经系统损伤和疾病。]适当的UTI管理和避免不必要的抗生素是 对于确保为这些高优先级患者提供高质量，安全护理的至关重要。这个创新的项目 将研究一系列NB患者[由于SCI，MS和PD]在各种不同的VA医院受到关注的患者 地理位置和大小。它旨在表征为ASB和UTI提供的护理变化以及 使用电子的回顾性队列研究将它们与关键提供商和患者特征联系起来 健康记录数据。它进一步旨在使用定性方法来评估患者知识，吸引，相信， 以及对ASB和UTI的期望以及测量与UTI相关的患者报告的康复结果。在 这样，该项目代表了开发以患者为中心的ASB和 UTI管理。该项目的结果将用于支持Fitzpatrick博士的VA功绩评论 用于开发以患者为中心的多模式的干预措施的应用[改善功能和患者报告 NB患者改善ASB和UTI管理的康复结果。]特定组件 该项目中获得的数据将告知干预措施，并针对关键患者和护理 与高度管理率相关的设置。这项研究的结果也将为未来提供信息 努力使用电子健康记录数据来[为患者开发ASB和UTI的可计算表型 NB]将有助于未来的研究和质量改进项目，与改善ASB和UTI有关 管理。因此，预计该CDA2项目的完成将提供重要的基础。 为了改善健康，功能和生活质量的ASB和UTI管理的成功干预措施 由于慢性神经系统损伤和疾病而导致NB的退伍军人。