Title: Actionable Knowledge to Guide Antimicrobial Stewardship
Background: Antibiotic resistance among bacteria has become a major national and global concern, including in the VA medical system. Its rise increases the risk of a mismatch between antibiotic coverage and the disease-causing pathogen, resulting in excess morbidity, cost, and death. VHA Directive 1031 mandated antibiotic stewardship programs to address these concerns; however, they must navigate between two sometimes opposing interests: patient (successful treatment) and public interests (lower resistance). Furthermore, stewardship interventions need to be adapted to local patterns of antibiotic use and resistance-a process for which the evidence base is poor. This proposal will characterize stewardship information needs, build the evidence base, and use informatics methods to support antibiotic decision-making that benefit both individual Veterans and Veteran as a whole.
Research Aims: (1) Characterize the information needs and decision-making patterns of stewards when making antibiotic recommendations. (2) Identify predictors of antibiotic coverage and emergence of resistance from local antibiotic use and resistance data. (3) Develop a clinical decision-support system that nudges and prompts stewards to use local hospital data and test the influence on stewards.
Aim 1 will use naturalistic decision-making methods to map the decision-making process in a way that identifies information needs and informs the design of a decision-support tool. Aim 2 will use statistical models to find predictors of antibiotic coverage and resistance. Aim 3 will develop a prototype decision-support system and test its effect on how stewards handle resistance issues in a randomized-controlled trial. In year three, I will collaborate with implementation scientists and apply for an investigator-initiated research (IIR) award to pursue my career aims and introduce stewardship tools in a multi-center study.
Not yet available.
In recent years, we have demonstrated that both antimicrobial use and resistance have been improving in VA, which translates to better care for Veterans. This project has supported the development of data tools in this field for most VA medical centers, improving our understanding of what antimicrobial stewards need and delivering it to them. VA researchers now have greater capacity to do better antimicrobial research in greater quantity and faster than most of the premier institutions in the country. VA HSR&D research has the capability of leading the world in antimicrobial stewardship.
External Links for this Project
Grant Number: IK2HX001165-01A2
None at this time.