Title: Actionable Knowledge to Guide Antimicrobial Stewardship Introduction: This proposal utilizes VA research resources and partnerships to identify existing information and knowledge gaps of providers in antibiotic treatment; then develops and tests an informatics intervention designed to address them. 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. Career Aims: My overarching career goals are to: 1) become an independent HSRD&D investigator in the stewardship domain, 2) develop a comprehensive framework for weighing the risks and benefits of antibiotic treatment choices, and 3) architect VA systems to promote better antibiotics decisions through informatics.
Research Aims :
My research aims build toward my career 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. Methods:
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 coverag 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. Impact: The career plan outlined identifies the gaps between my current experience and skills and those needed to accomplish these research aims and establish a trajectory toward my career aims. It addresses the gaps through a research agenda, formal classes, and self-study in my domain of interest. The proposal also outlines a planned IIR mentioned above, as the next step on a career in the same vein. This proposal and career path will provide new insights and tools for stewardship; thereby improving effective antibiotic therapy and resistance among Veterans. Because stewardship is a special case of medication management, insights into decision-making processes and informatics solutions from this research have implications for medication management in general.
Antibiotic resistance is not an innate Veterans? health problem (e.g., diabetes), it is an unnecessary one caused by antibiotic use and frequently spread through the healthcare system?further jeopardizing the health of Veterans when they come to VA to seek care. It is so important that VHA Directive 1031 recently mandated antibiotic stewardship programs throughout the system. Stewardship programs have the difficult task of recommending antibiotics that meet individual patient interests while preserving antibiotic effectiveness for other patients. Unfortunately, guidelines are only able to provide direction in very general terms. My research will empower antibiotic stewardship programs to use their local data and optimize antibiotic care. It concentrates on delivering information in a way that ?nudges? stewards to make responsible recommendations for each Veteran, as well as Veterans as a whole.
|Jones, Barbara E; Haroldsen, Candace; Madaras-Kelly, Karl et al. (2018) In Data We Trust? Comparison of Electronic Versus Manual Abstraction of Antimicrobial Prescribing Quality Metrics for Hospitalized Veterans With Pneumonia. Med Care 56:626-633|