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: 10620614
• 负责人: CHARLESNIKA T EVANS
• 金额: --
• 依托单位: LOUIS STOKES CLEVELAND VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-05-01 至 2026-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10620614
• 关键词: Acute; Address; Administrator; Advisory Committees; Affect; Antibiotic Therapy; Antibiotics; Antimicrobial Resistance; Area; COVID-19; Caring; Cellulitis; Cessation of life; Clinical; Clinical Pharmacists; Clinical Practice Guideline; Clinical effectiveness; Collaborations; Communicable Diseases; Community Healthcare; Complex; Consultations; Cost Analysis; Data; Development; Dissemination and Implementation; Effectiveness; Evidence based intervention; Feedback; Goals; Guidelines; Health; Health Services; Health Services Accessibility; Healthcare; Healthcare Systems; Improve Access; Individual; Infection; Infection Control; Intervention; Interview; Length; Long-Term Care; Maps; Measures; Medical center; Mentors; Methodology; Methods; Modeling; Modification; Nurses; Outcome; Outcome Measure; Outpatients; Participant; Patient Care; Perception; Pharmacists; Physicians; Pilot Projects; Pneumonia; Policy Maker; Prevention; Process; Provider; Quality of Care; Randomized; Recommendation; Reporting; Resources; Risk Factors; Role; Rural; Rural Health; Services; Site; Specialist; Structure; System; Teleconferences; Testing; Training; United States Department of Veterans Affairs; Urinary tract infection; Veterans; Work; antimicrobial; care outcomes; care providers; clinical care; combat; design; effectiveness/implementation design; evidence base; evidence based guidelines; experience; feasibility testing; geographically distant; global health; healthcare-associated infections; implementation barriers; implementation cost; implementation evaluation; improved; innovation; interest; medical specialties; member; military veteran; multidisciplinary; novel coronavirus; novel strategies; operation; pathogen; patient safety; patient subsets; peer; pharmacy benefit; prevent; primary outcome; programs; secondary outcome; telehealth; videoconference

Background: Antimicrobial stewardship guidelines call for a multidisciplinary team with an infectious disease (ID) physician and ID-trained clinical pharmacist as core members. Unfortunately, there are insufficient ID- trained specialists to staff on-site antimicrobial stewardship programs throughout VA. Significance: This proposal is highly significant for Veterans and the goals of VA. Veterans experience many of the risk factors associated with development of antimicrobial resistant and healthcare-associated infections. The unprecedented effects of the novel Coronavirus disease 2019 (COVID-19) on the health of our Veterans and on our entire healthcare system makes the demand for ID expertise even more apparent, especially in long-term care. Also, this study directly addresses the VA MISSION ACT to improve access to care, timeliness and quality of care, using telehealth services. Finally, this project is aligned with the priorities of our operation partners: VA Antimicrobial Stewardship Taskforce (ASTF), the VA National Infectious Disease Service (NIDS), VA Pharmacy Benefits Management (PBM) Services, and the Office of Rural Health. Innovation and Impact: The design is innovative because we will systematically test and assess implementation barriers to telehealth for antimicrobial stewardship, a novel approach that has not been implemented in VA facilities, other than in our previous pilot study. Further, the Antibiotic Use Reports (AURs) are an innovative adaptation of peer-comparison, an antibiotic stewardship strategy successful in outpatient settings. This project will provide findings for a scalable model that could be deployed nationally to all applicable VAMCs, continuing the role of VHA as a leader in implementing large-scale interventions focused on prevention and management of ID and stewardship. Specific Aims: Our goal is to implement a multidisciplinary videoconference antimicrobial stewardship team (VAST) in VAMCs using SCAN-ECHO. Our central hypothesis is that feedback reports that quantify facility- level antibiotic use will enhance the efficacy of VASTs to support antimicrobial stewardship. We propose a Type 2 hybrid effectiveness-implementation design, comparing clinical effectiveness in sites that implement the VAST alone (VAST-) to sites that implement the VAST augmented by facility-level Antibiotic Use Reports (VAST+). Aims are: 1) Identify and test effective strategies for implementing the VAST; 2) Determine the influence of the VAST overall and VAST+ on the care of Veterans with suspected infections; 3) Determine the influence of the VAST overall and VAST+ on antibiotic use at each VAMC. Methodology: We will randomize rural VAMCs that do not have ID-trained professionals on staff to implement the VAST alone (VAST-) versus VAST + antibiotic use feedback (VAST+). Aim 1: We will assess modification and adaptations at the intervention sites and by the infectious disease experts. Methods will include process maps and semi-structured interviews to gather qualitative data about what key VAST members perceive as facilitators, barriers and burden to VAST implementation. We will also evaluate costs of implementation. Aim 2: We will evaluate the Veteran population served, clinical activities, and user perceptions of the VAST. We will assess the concordance of clinical care with recommendations from evidence-based clinical practice guidelines. VAST members’ perceptions of the quality and timeliness of care will be evaluated. Aim 3: The primary outcome measure will be overall rates of antibiotic use. Secondary outcomes will be changes in the rates of broad-spectrum antibiotic use, antibiotic starts, and length of antibiotic therapy. Next steps/Implementation: Testing effective implementation of the VAST at additional VAMCs is an important step toward augmenting antimicrobial stewardship in both acute- and long-term care settings. In collaboration with VA clinical operation partners, outcomes from this trial will be used to roll-out an implementation playbook to be used by other VAMCs, as well as non-VA settings.

背景：抗菌管理指南要求具有传染病的多学科团队 （ID）作为核心成员的身体和ID训练的临床药剂师。不幸的是，ID不足 培训的专家为整个VA的员工现场抗菌管理计划。 意义：该提议对于退伍军人和VA的目标非常重要。退伍军人经历了很多 与抗菌素耐药性和与医疗保健相关感染的发展相关的危险因素。 2019年新型冠状病毒病（COVID-19）对退伍军人的健康的前所未有的影响 在我们的整个医疗保健系统中，对ID专业知识的需求更加明显，尤其是在 长期护理。此外，这项研究直接解决了VA任务法，以改善获得护理的机会， 使用远程医疗服务的及时性和护理质量。最后，该项目与 我们的操作合作伙伴：VA抗菌管理工作组（ASTF），VA国家传染病 服务（NIDS），VA药房福利管理（PBM）服务和农村健康办公室。 创新和影响：设计具有创新性，因为我们将系统地测试和评估 远程医疗实施抗菌管理的障碍，这是一种新颖的方法 除了我们以前的试点研究中，在VA设施中实施。此外，抗生素使用报告（AURS） 是对同伴比较的创新改编，这是一种抗生素管理策略，成功的门诊病人 设置。该项目将为可扩展模型提供发现，该模型可以在全国范围内部署给所有人 适用的VAMC，继续VHA作为实施大规模干预措施的领导者的角色 关于ID和管理的预防和管理。 具体目的：我们的目标是实施多学科视频会议抗菌管理团队 （大量）使用扫描回波在VAMC中。我们的中心假设是，反馈报告量化了设施 - 水平的抗生素使用将提高广泛支持抗菌剂的效率。我们提出了一个 2型混合有效性 - 实践设计，比较实施该地点的临床有效性 广阔的单独（广阔），以实施由设施级抗生素使用报告实施广泛增强的网站 （vast+）。目的是：1）确定和测试实施广大的有效策略； 2）确定 庞大而广泛的+对怀疑感染的退伍军人的照顾的影响； 3）确定 每个VAMC的巨大整体和广泛+对抗生素使用的影响。 方法论：我们将随机化没有由ID培训的专业人员实施的农村VAMC 广阔的单独（广阔）与广泛的抗生素使用反馈（vast +）。目标1：我们将评估修改 以及在干预地点和传染病专家的适应。方法将包括过程 地图和半结构化访谈，以收集有关哪些关键成员认为是什么关键的数据 促进者，障碍和伯恩实施巨大的实施。我们还将评估实施成本。目标2： 我们将评估所服务的资深人口，临床活动以及对广大的用户看法。我们将 评估临床护理与循证临床实践的建议的一致性 指南。将评估广泛的成员对护理质量和及时性的看法。目标3： 主要结果度量将是抗生素使用的总体速率。次要结果将是变化 广谱抗生素的使用率，抗生素开始和抗生素治疗的长度。 下一步/实施：测试在其他VAMC处有效实施的有效实施是一个 在急性和长期护理环境中增强抗菌管理的重要一步。在 与VA临床操作合作伙伴的合作，该试验的结果将用于推出 实施剧本将由其他VAMC以及非VA设置使用。