Intergovernmental Personnel Act Agreement for Kenzie Cameron

Background: Individuals with spinal cord injury or disorder (SCI/D) are at high risk for infections compared to the general patient population due to factors such as frequent hospitalization, previous antibiotic use, frequent and chronic use of invasive medical devices such as urinary catheters, and development of pressure ulcers. Many of these infections are caused by antimicrobial resistant organisms such as multidrug-resistant gram-negative bacteria or Methicillin-resistant Staphylococcus aureus. Because infections often require antimicrobial treatment, the opportunities for over-prescribing of antibiotics or inadequate antibiotic prescribing are common. Objective: The purpose of this study is to conduct a national mixed-methods study to assess variation in inadequate prescribing in BSI by hub and spoke facilities and implement a pilot antibiogram intervention to improve prescribing Aim 1: Examine the rate of inadequate antibiotic prescribing for BSIs among SCI/D patients by hub and spoke facilities. Aim 2: Conduct a qualitative formative evaluation to characterize best practices and challenges that influence the antibiotic decision-making processes of healthcare providers treating persons with SCI/D; including use of antibiograms Aim 3: Implement an SCI-unit specific antibiogram in one SCI unit. Methods: A mixed methods study employing both quantitative and qualitative approaches will be conducted. We will utilize national VA medical encounter data for the most recent year (i.e., currently FY2013; Oct. 1, 2012-Sep. 30, 2013) Utilizing our analysis, we will select up to 12 facilities (4 hubs and 8 spoke sites) where provider interviews will be conducted. Data Analysis: Aim 1Analysis: We will utilize national VA data to examine the rate of inadequate prescribing by facility using chi-square, odds rations, and mixed models. Aim 2 Analysis: Analysis of the interview data will proceed through coding using latent content and constant comparative techniques, deriving basic concepts from data and comparing them with other data to facilitate meaningful categorization. Aim 3: WE will initiate a phase 1 pilot of the SCI-unit specific antibiogram program at one VA facility, which will provide lessons learned permitting refinement of the program and identifying information on program acceptance, feasibility, and impacts in a rapid manner. Relevance to VA: This project is designed to fulfill both SCI QUERI and SCI/D Service goals. Infection prevention and management is a primary focus area for SCI QUERI and our working group of ID, implementation, and health services research experts identified antimicrobial stewardship as a major area of emphasis. The proposed study is focused on improving the adequacy of empiric and definitive treatment of BSIs. We expect that this project will contribute to our understanding of the complexities of treatment and management decisions for infections in Veterans with SCI/D.