Quantifying the Implementation and Cost of a Multisite Antibiotic Stewardship Intervention for Asymptomatic Bacteriuria
Abstract Objective: The intensity of an antibiotic stewardship intervention to achieve clinical impact is not known. We conducted a multisite dissemination project of an intervention to reduce treatment of asymptomatic bacteriuria (ASB) and studied: (1) the association between implementation metri...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Cambridge University Press
2023-01-01
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| Series: | Antimicrobial Stewardship & Healthcare Epidemiology |
| Online Access: | https://www.cambridge.org/core/product/identifier/S2732494X23001985/type/journal_article |
| _version_ | 1797791662617919488 |
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| author | Eva Amenta Larissa Grigoryan Suja S. Rajan David Ramsey Jennifer R. Kramer Annette Walder Andrew Chou John N. Van Sarah L. Krein Sylvia Hysong Aanand D. Naik Barbara W. Trautner |
| author_facet | Eva Amenta Larissa Grigoryan Suja S. Rajan David Ramsey Jennifer R. Kramer Annette Walder Andrew Chou John N. Van Sarah L. Krein Sylvia Hysong Aanand D. Naik Barbara W. Trautner |
| author_sort | Eva Amenta |
| collection | DOAJ |
| description |
Abstract
Objective:
The intensity of an antibiotic stewardship intervention to achieve clinical impact is not known. We conducted a multisite dissemination project of an intervention to reduce treatment of asymptomatic bacteriuria (ASB) and studied: (1) the association between implementation metrics and clinical outcomes and (2) the cost of implementation.
Design/Setting/Participants:
A central site facilitated a multimodality intervention to decrease unnecessary urine cultures and antibiotic treatment in patients with ASB at 4 Veterans Affairs medical centers.
Methods:
The intervention consisted of a decision support aid algorithm and interactive teaching cases that provided in the moment audit and feedback on how to manage ASB. Implementation outcomes included minutes spent in intervention delivery, number of healthcare professionals reached, and number of sessions delivered. Clinical outcomes included days of antibiotic therapy (DOT), length of antibiotic therapy (LOT), and number of urine cultures ordered per 1000 bed days. Personnel reported weekly time logs.
Results:
Minutes spent in intervention delivery were inversely correlated with two clinical outcomes, DOT (R −0.3, P = .04) and LOT (R −0.3, P = .02). Number of healthcare professionals reached and number of sessions delivered were not correlated with clinical outcomes of DOT (R –0.003, P = .98, R = −0.059, P = .69) or LOT (R +0.073, P = .62, R −0.102, P = .49). Physician champions spent an average of 3.8% of effort on the intervention. The implementation cost was USD 22,299/year per site on average.
Conclusions:
The amount of time local teams spent in delivery of an antibiotic stewardship intervention was correlated with the desired decrease in antibiotic use. Implementing this successful antibiotic stewardship intervention required minimal time.
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| first_indexed | 2024-03-13T02:22:03Z |
| format | Article |
| id | doaj.art-761d8e388a5e41a5afe04dbdc2b7a7df |
| institution | Directory Open Access Journal |
| issn | 2732-494X |
| language | English |
| last_indexed | 2024-03-13T02:22:03Z |
| publishDate | 2023-01-01 |
| publisher | Cambridge University Press |
| record_format | Article |
| series | Antimicrobial Stewardship & Healthcare Epidemiology |
| spelling | doaj.art-761d8e388a5e41a5afe04dbdc2b7a7df2023-06-30T07:45:35ZengCambridge University PressAntimicrobial Stewardship & Healthcare Epidemiology2732-494X2023-01-01310.1017/ash.2023.198Quantifying the Implementation and Cost of a Multisite Antibiotic Stewardship Intervention for Asymptomatic BacteriuriaEva Amenta0https://orcid.org/0000-0002-9224-7056Larissa Grigoryan1Suja S. Rajan2David Ramsey3Jennifer R. Kramer4Annette Walder5https://orcid.org/0000-0003-4799-6039Andrew Chou6https://orcid.org/0000-0002-2520-6959John N. Van7Sarah L. Krein8Sylvia Hysong9https://orcid.org/0000-0002-9063-5207Aanand D. Naik10https://orcid.org/0000-0001-6936-7984Barbara W. Trautner11https://orcid.org/0000-0001-7986-9099Michael E. DeBakey Veteran Affairs Medical Center, Center for Innovations in Quality, Effectiveness, and Safety (IQuESt), Houston, TX, USA Section of Infectious Diseases, Department of Medicine, Baylor College of Medicine, Houston, TX, USAMichael E. DeBakey Veteran Affairs Medical Center, Center for Innovations in Quality, Effectiveness, and Safety (IQuESt), Houston, TX, USA Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX, USAUTHealth Science Center, Institute for Stroke and Cerebral Vascular Disease, Houston, TX, USAMichael E. DeBakey Veteran Affairs Medical Center, Center for Innovations in Quality, Effectiveness, and Safety (IQuESt), Houston, TX, USA Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USAMichael E. DeBakey Veteran Affairs Medical Center, Center for Innovations in Quality, Effectiveness, and Safety (IQuESt), Houston, TX, USA Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USAMichael E. DeBakey Veteran Affairs Medical Center, Center for Innovations in Quality, Effectiveness, and Safety (IQuESt), Houston, TX, USA Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USAMichael E. DeBakey Veteran Affairs Medical Center, Center for Innovations in Quality, Effectiveness, and Safety (IQuESt), Houston, TX, USA Section of Infectious Diseases, Department of Medicine, Baylor College of Medicine, Houston, TX, USAMichael E. DeBakey Veteran Affairs Medical Center, Center for Innovations in Quality, Effectiveness, and Safety (IQuESt), Houston, TX, USACenter for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA Department of Medicine, University of Michigan, Ann Arbor, MI, USAMichael E. DeBakey Veteran Affairs Medical Center, Center for Innovations in Quality, Effectiveness, and Safety (IQuESt), Houston, TX, USA Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USAMichael E. DeBakey Veteran Affairs Medical Center, Center for Innovations in Quality, Effectiveness, and Safety (IQuESt), Houston, TX, USA Department of Management, Policy and Community Health, University of Texas School of Public Health, Houston, TX, USA UTHealth Consortium on Aging, University of Texas Health Science Center, Houston, TX, USAMichael E. DeBakey Veteran Affairs Medical Center, Center for Innovations in Quality, Effectiveness, and Safety (IQuESt), Houston, TX, USA Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USA Abstract Objective: The intensity of an antibiotic stewardship intervention to achieve clinical impact is not known. We conducted a multisite dissemination project of an intervention to reduce treatment of asymptomatic bacteriuria (ASB) and studied: (1) the association between implementation metrics and clinical outcomes and (2) the cost of implementation. Design/Setting/Participants: A central site facilitated a multimodality intervention to decrease unnecessary urine cultures and antibiotic treatment in patients with ASB at 4 Veterans Affairs medical centers. Methods: The intervention consisted of a decision support aid algorithm and interactive teaching cases that provided in the moment audit and feedback on how to manage ASB. Implementation outcomes included minutes spent in intervention delivery, number of healthcare professionals reached, and number of sessions delivered. Clinical outcomes included days of antibiotic therapy (DOT), length of antibiotic therapy (LOT), and number of urine cultures ordered per 1000 bed days. Personnel reported weekly time logs. Results: Minutes spent in intervention delivery were inversely correlated with two clinical outcomes, DOT (R −0.3, P = .04) and LOT (R −0.3, P = .02). Number of healthcare professionals reached and number of sessions delivered were not correlated with clinical outcomes of DOT (R –0.003, P = .98, R = −0.059, P = .69) or LOT (R +0.073, P = .62, R −0.102, P = .49). Physician champions spent an average of 3.8% of effort on the intervention. The implementation cost was USD 22,299/year per site on average. Conclusions: The amount of time local teams spent in delivery of an antibiotic stewardship intervention was correlated with the desired decrease in antibiotic use. Implementing this successful antibiotic stewardship intervention required minimal time. https://www.cambridge.org/core/product/identifier/S2732494X23001985/type/journal_article |
| spellingShingle | Eva Amenta Larissa Grigoryan Suja S. Rajan David Ramsey Jennifer R. Kramer Annette Walder Andrew Chou John N. Van Sarah L. Krein Sylvia Hysong Aanand D. Naik Barbara W. Trautner Quantifying the Implementation and Cost of a Multisite Antibiotic Stewardship Intervention for Asymptomatic Bacteriuria Antimicrobial Stewardship & Healthcare Epidemiology |
| title | Quantifying the Implementation and Cost of a Multisite Antibiotic Stewardship Intervention for Asymptomatic Bacteriuria |
| title_full | Quantifying the Implementation and Cost of a Multisite Antibiotic Stewardship Intervention for Asymptomatic Bacteriuria |
| title_fullStr | Quantifying the Implementation and Cost of a Multisite Antibiotic Stewardship Intervention for Asymptomatic Bacteriuria |
| title_full_unstemmed | Quantifying the Implementation and Cost of a Multisite Antibiotic Stewardship Intervention for Asymptomatic Bacteriuria |
| title_short | Quantifying the Implementation and Cost of a Multisite Antibiotic Stewardship Intervention for Asymptomatic Bacteriuria |
| title_sort | quantifying the implementation and cost of a multisite antibiotic stewardship intervention for asymptomatic bacteriuria |
| url | https://www.cambridge.org/core/product/identifier/S2732494X23001985/type/journal_article |
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