Implementation and Evaluation of a Video-based Prospective Feedback Intervention to Improve Antimicrobial Stewardship in Neonatal Intensive Care Units

基于视频的前瞻性反馈干预措施的实施和评估，以改善新生儿重症监护病房的抗菌药物管理

• 批准号: 9793441
• 负责人: PETER JAMES MENDEL
• 金额: $ 50万
• 依托单位: RAND CORPORATION
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-01 至 2023-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9793441
• 关键词: Implementation; Evaluation; Video; based; Prospective

Summary/Abstract The problem of antimicrobial misuse is well known and is a high priority action item for all of the major public health, infectious disease and US primary care societies. This reflects the existence of untreatable bacterial infections, a shallow manufacturer pipeline for new antibiotics, and continued misuse of antimicrobials by providers. In the neonatal intensive care unit (NICU) setting, antibiotics are the most frequently used medications, and very often inappropriately. Such use is associated with increased bacterial resistance, increased hospital length of stay, necrotizing enterocolitis, and even death. Drug usage decisions can be difficult in the NICU as infectious and non‐infectious conditions present similarly often leading to empiric overtreatment. Thus, it is not surprising there is substantial variation in antibiotic use among NICUs. Antimicrobial stewardship programs (ASP) mitigate against the consequences of poor antibiotic use resulting in improved patient outcomes, fewer adverse events, improved bacterial susceptibilities, and economic savings. Several ASP strategies are recommended, however common implementation problems include lack of provider buy‐in, consensus on best practice, attention to interactions among prescribers and other staff who manage patients, and tailoring of ASPs to clinical and institutional contexts. These challenges are exacerbated in settings in which high heterogeneity in patient indications and lack of expert consensus on treatment is present, such as the NICU. We propose to evaluate an innovative, scalable antimicrobial stewardship intervention called ECHO‐ ASP in NICUs participating in the largest statewide perinatal QI collaborative in the US. The intervention pairs prospective feedback (an ASP practice recommended by CDC) with the ECHO tele‐learning platform (Extension for Community Healthcare Outcomes). ECHO is an evidence‐based method of practice dissemination used globally in >120 health collaborations since 2003. Both parts of the ECHO‐ASP intervention—prospective feedback and the ECHO methodology—are grounded in an expert‐facilitated, case‐based learning model tailored to how clinicians are inclined to learn and build practice consensus. The Specific Aims of the project are to: 1) Evaluate the implementation of the ECHO‐ASP intervention including barriers and facilitators to implementation, site participation in video‐based prospective feedback and audit sessions, dissemination of session results to other local NICU prescribers, perceived acceptability and durability of the intervention, and practice consensus on antibiotic prescribing; 2) Evaluate the effectiveness of the ECHO ASP intervention on patient care outcomes, including antibiotic use, drug‐related adverse events, and other clinical complications; 3) Evaluate the cost implications of the ECHO ASP intervention, including implementation costs and effects on costs of care.

摘要/摘要 抗菌药物滥用问题是众所周知的，并且是所有主要机构的高度优先行动项目。 公共卫生、传染病和美国初级保健协会这反映了无法治疗的情况的存在。 细菌感染、新抗生素制造商渠道薄弱以及持续滥用 在新生儿重症监护病房 (NICU) 环境中，抗生素是最多的。 经常使用的药物，而且通常不恰当地使用会导致药物的增加。 细菌耐药性、住院时间增加、坏死性小肠结肠炎，甚至死亡。 在新生儿重症监护病房 (NICU) 中，由于感染性和非感染性病症的表现相似，因此做出使用决定可能很困难 通常会导致经验性过度治疗，因此抗生素存在巨大差异也就不足为奇了。 NICU 中抗菌药物管理计划 (ASP) 的使用减轻了贫困的后果。 抗生素的使用可以改善患者的治疗效果、减少不良事件、改善细菌状况 建议采用几种 ASP 策略，但很常见。 实施问题包括缺乏提供商的支持、对最佳实践的共识、对 处方者和管理患者的其他工作人员之间的互动，以及根据临床和情况定制 ASP 在患者存在高度异质性的环境中，这些挑战会加剧。 存在适应症和治疗缺乏专家共识，例如 NICU。 我们建议评估一种创新的、可扩展的抗菌药物管理干预措施，称为 ECHO‐ NICU 中的 ASP 参与了美国最大的全州围产期 QI 协作干预。 将前瞻性反馈（CDC 推荐的 ASP 实践）与 ECHO 远程学习平台结合起来 （社区医疗保健成果的扩展）。ECHO 是一种基于证据的实践方法。 自 2003 年以来，在全球超过 120 个卫生合作中使用了传播技术。ECHO-ASP 的两个部分 干预——前瞻性反馈和 ECHO 方法——以专家推动的、 基于案例的学习模式，适合教师如何学习和建立实践共识。 该项目的具体目标是： 1) 评估 ECHO-ASP 干预措施的实施情况 包括并促进实施、现场参与基于视频的前瞻性 反馈和审核会议，将会议结果传播给其他当地 NICU 处方医生，感知 干预措施的可接受性和持久性，以及抗生素处方的实践共识2) 评估 ECHO ASP 干预对患者护理结果（包括抗生素）的有效性 3) 评估药物相关的不良事件和其他临床并发症的成本影响； ECHO ASP 干预，包括实施成本和对护理成本的影响。