Antimicrobial stewardship to combat the spread of antibiotic-resistant bacteria has become a national priority. This project focuses on reducing inappropriate use of antimicrobials for asymptomatic bacteriuria (ASB), a very common condition that leads to antimicrobial overuse in acute and long-term care. We previously conducted a successful intervention, entitled "Kicking Catheter Associated Urinary Tract Infection (CAUTI): the No Knee-Jerk Antibiotics Campaign," to decrease guideline-discordant ordering of urine cultures and antibiotics for ASB. The current objective is to facilitate implementation of a scalable version of the Kicking CAUTI campaign across four geographically diverse Veterans Health Administration facilities while assessing what aspects of an antimicrobial stewardship intervention are essential to success and sustainability.
This project uses an interrupted time series design with four control sites. The two main intervention tools are (1) an evidence-based algorithm that distills the guidelines into a streamlined clinical pathway and (2) case-based audit and feedback to train clinicians to use the algorithm. Our conceptual framework for the development and implementation of this intervention draws on May's General Theory of Implementation. The intervention is directed at providers in acute and long-term care, and the goal is to reduce inappropriate screening for and treatment of ASB in all patients and residents, not just those with urinary catheters. The start-up for each facility consists of centrally-led phone calls with local site champions and baseline surveys. Case-based audit and feedback will begin at a given site after the start-up period and continue for 12 months, followed by a sustainability assessment. In addition to the clinical outcomes, we will explore the relationship between the dose of the intervention and clinical outcomes.
This project moves from a proof-of-concept effectiveness study to implementation involving significantly more sites, and uses the General Theory of Implementation to embed the intervention into normal processes of care with usual care providers. Aspects of implementation that will be explored include dissemination, internal and external facilitation, and organizational partnerships. "Less is More" is the natural next step from our prior successful Kicking CAUTI intervention, and has the potential to improve patient care while advancing the science of implementation.
Implementation science : IS. 2018 Jan 19*** epublish ***
Barbara W Trautner, Pooja Prasad, Larissa Grigoryan, Sylvia J Hysong, Jennifer R Kramer, Suja Rajan, Nancy J Petersen, Tracey Rosen, Dimitri M Drekonja, Christopher Graber, Payal Patel, Paola Lichtenberger, Timothy P Gauthier, Steve Wiseman, Makoto Jones, Anne Sales, Sarah Krein, Aanand Dinkar Naik, Less is More Study Group
Center for Innovations in Quality, Effectiveness, and Safety (IQuESt) (152), Michael E. DeBakey Veterans Affairs Medical Center, 2002 Holcombe Boulevard, Houston, TX, 77030, USA. ., Rice University, Houston, USA., Department of Family and Community Medicine, Baylor College of Medicine, 3701 Kirby Drive, Suite 600, Houston, TX, 77098, USA., Center for Innovations in Quality, Effectiveness, and Safety (IQuESt) (152), Michael E. DeBakey Veterans Affairs Medical Center, 2002 Holcombe Boulevard, Houston, TX, 77030, USA., Department of Management, Policy and Community Heath, University of Texas (UT) - School of Public Health (SPH), E-319, 1200 Pressler Street, Houston, TX, 77030, USA., Infectious Diseases (111F), Minneapolis VA Medical Center, 1 Veterans Drive, Minneapolis, MN, 55417, USA., Infectious Diseases Section, VA Greater Los Angeles Healthcare System, David Geffen School of Medicine at UCLA, 11301 Wilshire Blvd, 111-F, Los Angeles, CA, 90073, USA., Division of Infectious Diseases, III-i, University of Michigan, 2215 Fuller Road, Ann Arbor, MI, 48105, USA., Bruce W. Carter VAMC, 1201 NW 16th Street, Miami, FL, 33125-1693, USA., George E. Wahlen Veterans Affairs Medical Center, Mailstop 182, 500 Foothill Drive, Salt Lake City, UT, 84148, USA., Department of Learning Health Sciences, University of Michigan Medical School, 209 Victor Vaughan Building, 2054, 1111 E. Catherine St, Ann Arbor, MI, 48109-2054, USA., VA Ann Arbor Center for Clinical Management Research, North Campus Research Complex, Building 16-333W, 2800 Plymouth Rd, Ann Arbor, MI, 48109-2800, USA.