Development, Validation and Real-World Application of Comprehensive Metrics to Improve Hospitals' Antibiotic Prescribing

改善医院抗生素处方的综合指标的开发、验证和实际应用

• 批准号: 10636459
• 负责人: Michihiko Goto
• 金额: --
• 依托单位: IOWA CITY VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-07-01 至 2027-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10636459
• 关键词: Address; Advisory Committees; Antibiotics; Antimicrobial Resistance; Bacteria; Beds; Case Mixes; Consensus; Data; Development; Disease; Educational process of instructing; Effectiveness; Exercise; Feedback; Focus Groups; Future; Goals; Health Policy; Healthcare; Hospital Administration; Hospitalization; Hospitals; Human; Inpatients; Interview; Knowledge; Length of Stay; Location; Mathematics; Measures; Methodology; Methods; Patients; Performance; Process; Public Health; Qualitative Methods; Quality of Care; Recommendation; Reporting; Research; Risk; Risk Adjustment; Risk Factors; Role; Safety; Site; Standardization; Structure; Surveys; Techniques; Validation; Variant; Veterans; Veterans Health Administration; Work; acute care; antimicrobial; dashboard; data integration; emerging antimicrobial resistance; hospital care; hospital performance; improved; innovation; novel; patient safety; programs; real world application; response; success; tool

Background: Antimicrobial resistance is an urgent public health problem and a threat to patient safety. Antimicrobial use is the strongest risk factor for the emergence of antimicrobial resistance By reducing unnecessary antimicrobial use and improving necessary use, antimicrobial stewardship programs (ASPs) are an important tool in the battle against antimicrobial resistance. ASPs are mandated both in and outside VHA. Significance: There is not a universally accepted metric to assess ASP success. A hospital-level metric, known as the Standardized Antimicrobial Administration Ratio (SAAR), is being widely implemented across US hospitals, including in VHA. However, the SAAR has not been validated and has several weaknesses, including lack of patient-level risk adjustment and no consideration for antimicrobial spectrum of activity. Innovation & Impact: This proposal will target a critical research gap by developing, refining and validating novel metrics that address the limitations of the SAAR. These novel metrics include: 1) a risk-standardized days of therapy (DOT) ratio (RSDTR), which differs from the SAAR in its adjustment for differences in patient case-mix; 2) a Days of Antimicrobial Spectrum Coverage (DASC) score, which differs from the SAAR in its capture of both antimicrobial use and spectrum of activity, and 3) a risk-standardized DASC. Through our aims, we will assess 3 types of validity (construct, content and predictive) for the SAAR and the 3 novel metrics. Specific Aims: A1: Identify non-modifiable factors that contribute to appropriate variation in antimicrobial use across VHA acute-care hospitals by evaluating potential patient-level, hospital-level, and environmental effects. H1: Non-modifiable factors can be identified by consensus-building exercises and mathematical techniques. A2: Evaluate whether hospitals that have implemented more robust stewardship processes, as measured by a mandatory VHA survey, perform better on the SAAR and the three novel metrics. H2: The association between the robustness of stewardship and a hospital's metric performance will be strongest for the risk-standardized DASC score. A3: Using qualitative methods, assess the content validity of the SAAR and the three novel metrics among key stakeholders across ten hospitals, including high and low-performing sites. H3: Key stakeholders across all sites will confirm the validity of the RSDTR and risk-standardized DASC and will have concerns about the validity of metrics that do not involve patient-level risk-adjustment. A4: Evaluate the longitudinal relationship between a hospital's performance on the four metrics and the emergence of healthcare-associated antimicrobial resistance. H4: The novel metrics will have a stronger association with future antimicrobial resistance than the SAAR. Methodology: Our proposal will leverage both quantitative and qualitative methods. In Aim 1, we will use a modified two-stage Delphi method, which will integrate data-driven and human-driven selection strategies, to identify non-modifiable risk factors that should be used to risk-standardize DASC and also DOT (e.g. the RSDTR metric). In Aim 2, we will use hospitals' responses to a mandatory survey to measure the association between the intensity of stewardship activities and metric performance (construct validity). In Aim 3, we will perform semi-structured interviews and focus groups with key stakeholders to assess the content validity of the four metrics. In Aim 4, we will leverage 17 years of VHA data to determine whether a hospital's performance on each metric is associated with the future development of antimicrobial resistance (predictive validity). Next Steps/Implementation: Any metric we validate would inform health policy and could be incorporated into our team's existing stewardship dashboard. Our findings could be used in a multicenter, audit-and-feedback trial that leverages the dashboard and the validated metric(s) to improve inpatient antimicrobial use.

背景：抗菌素耐药性是一个紧迫的公共卫生问题，对患者安全构成威胁。 抗菌使用是通过减少抗菌抗性的最强风险因素 不必要的抗菌使用和改善必要的使用，抗菌管理计划（ASP）是 反对抗菌抗性的重要工具。 ASP在VHA内部和外部都被授权。 意义：没有一个公认的指标来评估ASP成功。医院级指标， 在我们的整个美国，被称为标准化的抗微生物给药比（SAAR）。 医院，包括VHA。但是，SAAR尚未得到验证，并且有几个弱点， 包括缺乏患者水平的风险调整，不考虑活性抗菌谱。 创新与影响：该提案将通过开发，完善和验证来针对关键的研究差距 解决SAAR的局限性的新颖指标。这些新颖的指标包括：1）风险标准化 治疗日（DOT）比率（RSDTR），它与SAAR的不同之处在于患者的差异 案例混合； 2）一天的抗菌光谱覆盖范围（DASC）得分，与SAAR不同 捕获抗菌使用和活性范围，以及3）风险标准化的DASC。通过我们的目标 我们将评估SAAR和3种新型指标的3种类型的有效性（构建，内容和预测性）。 具体目的： A1：确定不可修道的因素，这些因素导致VHA抗菌使用的适当变化 通过评估潜在的患者水平，医院水平和环境影响，急性护理医院。 H1：可以通过共识练习和数学技术来识别不可修改的因素。 A2：评估是否实施了更强大的管理流程的医院 强制性VHA调查，在SAAR和三个新颖的指标上表现更好。 H2：管理的稳健性与医院的指标表现之间的关联将是 风险标准化的DASC得分最强。 A3：使用定性方法，评估SAAR的内容有效性和密钥中的三个新颖指标 十家医院的利益相关者，包括高性能和低表现地点。 H3：所有站点的主要利益相关者将确认RSDTR和风险标准的DASC和 将担心不涉及患者级风险调整的指标的有效性。 A4：评估医院在四个指标上的纵向关系与 与医疗保健相关的抗菌耐药性的出现。 H4：新型指标将与未来的抗菌耐药性更强，而不是SAAR。 方法：我们的建议将利用定量和定性方法。在AIM 1中，我们将使用 修改了两阶段的Delphi方法，该方法将将数据驱动和人为驱动的选择策略整合到 确定应使用的不可修改的危险因素，这些风险因素应用于风险标准化DASC和DOT（例如 RSDTR度量）。在AIM 2中，我们将使用医院对强制性调查的回应来衡量协会 在管理活动的强度与度量绩效（构造有效性）之间。在AIM 3中，我们将 与主要利益相关者进行半结构化访谈和焦点小组，以评估 四个指标。在AIM 4中，我们将利用17年的VHA数据来确定医院是否在 每个度量与抗菌耐药性的未来发展有关（预测有效性）。 下一步/实施：我们验证的任何指标都将为卫生政策提供信息，并可以纳入 我们团队现有的管理仪表板。我们的发现可以用于多中心，审核和反馈 利用仪表板和经过验证的度量标准以改善住院抗菌使用的试验。