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: 10672768
• 负责人: CHARLESNIKA T EVANS
• 金额: --
• 依托单位: EDWARD HINES JR VA HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-10-01 至 2024-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10672768
• 关键词: Accounting; Acute respiratory infection; Address; Advisory Committees; African American population; Age; Ambulatory Care Facilities; Antibiotics; Antimicrobial Resistance; Bacteria; Bacteriuria; Categories; Characteristics; Chronic; Clinical; Clinical Practice Guideline; Collaborations; Communicable Diseases; Communication; Complex; Data; Development; Diagnosis; Diagnostic; Disparity; Dissemination and Implementation; Elements; Ethnic Origin; Ethnic Population; Evaluation; Event; Feedback; Goals; Guidelines; Health; Health Disparities Research; Health Promotion; Health Services; Health system; Healthcare; Hispanic Populations; Hospitals; Infection; Infection Control; Infection prevention; Intervention; Logistic Regressions; Medical; Medical Electronics; Medical center; Mentors; Mentorship; Methodology; Modeling; Nature; Nose; Nurses; Outpatients; Parents; Patients; Persons; Pharmacists; Pharyngeal structure; Physicians; Play; Predictive Factor; Process; Provider; Race; Random Allocation; Recommendation; Reporting; Research; Research Personnel; Resistance; Retrospective cohort; Retrospective cohort study; Robin bird; Role; Rural; Rural Health; Sampling; Scientist; Series; Signs and Symptoms; Site; Societies; Specialist; System; Uninsured; United States; Urinary tract infection; Urine; Veterans; Videoconferencing; Viral; Work; acute infection; antimicrobial; career; cohort; design; experience; follow-up; geographically distant; global health; health disparity; health equity; human old age (65+); improved; innovation; interdisciplinary approach; meetings; multi-drug resistant pathogen; operation; pathogen; prevent; programs; racial population; statistics; telehealth; tool; videoconference

Background: Antimicrobial-resistant and healthcare-associated pathogens are a serious threat in the United States, accounting for over 3 million infections each year. Antimicrobial stewardship remains the strongest tool in reducing the over prescribing of antibiotics, the leading modifiable cause of resistance. Despite this, inappropriate antibiotic use is still common in the VA. Furthermore, little is known about the role health disparities play in antibiotic inappropriate antibiotic prescribing. Significance: This proposal is highly significant for Veterans and the goals of VA. Previous studies have shown that additional antimicrobial stewardship efforts are needed in VA outpatient settings. Additionally, this project will provide evidence on health disparities and system factors that can be targeted in interventions to improve VA outpatient antibiotic prescribing. This project is aligned with the priorities of our operation partners: the VA Antimicrobial Stewardship Task Force and the Office of Rural Health. Specific Aims: The goal of this proposal will be to evaluate the patient and system factors that drive inappropriate antibiotic prescribing at the Videoconferencing Antimicrobial Stewardship Team (VAST) study sites using integrated health disparities and antimicrobial stewardship frameworks. Aim 1: Determine the percentage of antibiotic over-prescribing and under-prescribing for acute respiratory infections that occur by Veteran's race/ethnicity in VAST sites. Aim 2: Determine the percentage of antibiotic over-prescribing and under-prescribing by Veteran's race/ethnicity for urinary tract infections in VAST sites. Aim 3: Explore the system factors that predict the rate of over/under prescription of antibiotics by race/ethnicity. Methodology: For Aim 1, a retrospective cohort design will include outpatients from the 16 VAST study sites with a diagnosis of acute respiratory infection. The percentage of over-prescribing, and under-prescribing will be determined using criteria from clinical practice guidelines. Multinomial logistic regression models will determine the likelihood of patients correctly treated, over, or under-prescribed antibiotics by race/ethnicity. For Aim 2, a randomly selected sample of outpatients presenting with a urinary tract infection will be examined using electronic medical reviews to determine whether the diagnosis and treatment of urinary tract infection was appropriate according to clinical practice guidelines. The ratio of appropriately diagnosed and prescribed events will be evaluated by race/ethnicity. Aim 3 will use the same cohorts described in Aims 1 & 2 to determine the difference in antibiotic prescribing practices by system factors. Hierarchical logistic regression models will determine the likelihood of patients being over or under-prescribed antibiotics. Candidate Background: Dr. Wilson has been a Research Health Scientist with the Center of Innovation for Complex Chronic Healthcare (CINCCH) at Edward Hines Jr. VA Medical Center since August 2019. She has collaborated on several infection prevention projects in collaboration with the VA Multidrug Resistant Organisms (MDRO) program office, the VA Quality Enhancement Research Initiative (QUERI) program, and the VA National Center for Health Promotion (NCP). Her career goal is to become an independent health services researcher with expertise in evaluating and implementing infection prevention, antimicrobial and diagnostic stewardship interventions. Mentors. Mentorship Plan: Dr. Wilson's mentoring team consists of Dr. Charlesnika Evans, a VA Research Career Scientist with over 20 years' experience in infection control and stewardship research, Dr. Robin Jump, a VA Infectious Disease physician with expertise in antibiotic stewardship, and Dr. Karen Saban, a VA Research Health Scientist and nurse with a background in health disparities research. In addition to monthly meetings with her team, Dr. Wilson will participate in a health equity course series offered through Johns Hopkins as well as professional development seminars through the VA Office of Health Equity.

背景：抗菌药物耐药性和医疗保健相关病原体是美国的严重威胁 各州每年感染人数超过 300 万。抗菌药物管理仍然是最有力的工具 减少抗生素的过度处方，这是耐药性的主要可改变原因。尽管如此， 抗生素的不当使用在退伍军人事务部仍然很常见。此外，人们对健康的作用知之甚少。 抗生素处方不当导致抗生素处方存在差异。 意义：该提案对于退伍军人和退伍军人事务部的目标非常重要。之前的研究有 研究表明，退伍军人事务部门诊需要额外的抗菌药物管理工作。另外，这 该项目将提供有关健康差异和系统因素的证据，这些证据可作为干预措施的目标 改善 VA 门诊抗生素处方。该项目符合我们运营合作伙伴的优先事项： 退伍军人管理局抗菌药物管理工作组和农村卫生办公室。 具体目标：该提案的目标是评估驱动患者和系统的因素 视频会议抗菌药物管理团队 (VAST) 研究中抗生素处方不当 使用综合健康差异和抗菌药物管理框架的网站。目标 1：确定 因以下原因发生的急性呼吸道感染抗生素过量处方和处方不足的百分比 VAST 网站中退伍军人的种族/民族。目标 2：确定抗生素过度处方的百分比和 在 VAST 站点，退伍军人的种族/族裔对尿路感染的处方不足。目标 3：探索 按种族/民族预测抗生素处方过量/不足率的系统因素。 方法：对于目标 1，回顾性队列设计将包括来自 16 个 VAST 研究中心的门诊患者 诊断为急性呼吸道感染。过度处方和处方不足的百分比将 使用临床实践指南中的标准来确定。多项式逻辑回归模型将 按种族/民族确定患者正确治疗、过量或不足抗生素治疗的可能性。为了 目标 2，随机抽取患有尿路感染的门诊患者样本进行检查 使用电子医疗评论来确定是否诊断和治疗尿路感染 根据临床实践指南是适当的。正确诊断和处方的比例 赛事将按种族/民族进行评估。目标 3 将使用目标 1 和 2 中描述的相同群组来 通过系统因素确定抗生素处方实践的差异。层次逻辑回归 模型将确定患者服用过量或不足抗生素的可能性。 候选人背景：威尔逊博士是创新中心的一名健康研究科学家 自 2019 年 8 月起，在小爱德华·海因斯退伍军人医疗中心接受复杂慢性医疗保健 (CINCCH)。 与 VA 多重耐药组织合作开展多个感染预防项目 生物体 (MDRO) 计划办公室、VA 质量增强研究计划 (QUERI) 计划以及 退伍军人管理局国家健康促进中心 (NCP)。她的职业目标是成为一名独立健康的人 服务研究人员，在评估和实施感染预防、抗菌和 诊断管理干预。 导师。导师计划：Wilson 博士的导师团队由 VA 研究人员 Charlesnika Evans 博士组成 Robin Jump 博士是一位职业科学家，在感染控制和管理研究方面拥有 20 多年的经验 退伍军人管理局传染病医生，具有抗生素管理方面的专业知识，以及退伍军人事务部凯伦·萨班 (Karen Saban) 博士 研究健康科学家和护士，具有健康差异研究背景。除了每月 与她的团队会面后，威尔逊博士将参加约翰斯提供的健康公平课程系列 霍普金斯大学以及退伍军人管理局健康公平办公室举办的专业发展研讨会。