Dissemination and Implementation of a Videoconference Antimicrobial Stewardship Team

NCT05319561 | Completed Results

• 2 other identifiers: IIR 20-246HX003364
• Study Type: interventional
• Target: 8
• Locations: 1 country
• Sites: 2

Brief Summary

Antimicrobial-resistant and healthcare-associated pathogens are a global health threat. The goals of antimicrobial stewardship are to minimize unnecessary and inappropriate antimicrobial use as a means to combat antimicrobial resistance. Previously, the investigators implemented a Videoconference Antimicrobial Stewardship Team (VAST) at 2 VA Medical Centers (VAMCs), using telehealth to connect clinicians at a rural VAMC to a geographically distant infectious disease expert Both VASTs successfully decreased overall antibiotic use in acute and long-term care units. This project will expand the VAST approach to other VAMCs and test the hypothesis that quarterly reports that quantify facility-level antibiotic use will enhance the efficacy of VASTs to support antimicrobial stewardship. This work will directly increase access to antimicrobial stewardship consultation at rural VA facilities, which are often underserved by infectious disease expertise.

Conditions

Common Infections; Urinary Tract Infections; Pneumonia

Keywords

antimicrobial stewardship; telehealth

Outcome Measures

Primary Outcomes (1)

• Days of Antibiotic Therapy Per 1000 Days of Care

  Days of antibiotic therapy per 1000 days of care (DOT/1000 DOC) measures the overall rate of antibiotic use and is a common metric that accounts for dose adjustments, such as for people who receive dialysis. Administration of any dose of an antimicrobial on a given day represents a single DOT for that agent, regardless of the number of times the doses are administered or the dose strength. This metric gauges overall antibiotic use, capturing both the number of prescriptions as well as the length of prescriptions issued. It also helps benchmark use across facilities, tracks prescribing trends, and assesses the impact of stewardship efforts.

  The study period was 15 months following each the first meeting held by each VAST. The first 3 months were considered a wash-in period. Data analysis focused on the subsequent 12 month period.

Secondary Outcomes (2)

• Days of Broad-spectrum Antibiotic Therapy Per 1000 Bed Days of Care

  The study period was 15 months following each the first meeting held by each VAST. The first 3 months were considered a wash-in period. Data analysis focused on the subsequent 12 month period.

• Antibiotic Starts (New Prescriptions)/1000 Bed Days of Care

  The study period was 15 months following each the first meeting held by each VAST. The first 3 months were considered a wash-in period. Data analysis focused on the subsequent 12 month period.

Study Arms (2)

VAST+

EXPERIMENTAL

Sites are rural VA Medical Centers that work with an ID physician at different VA to conduct regular discussions about infectious diseases and antimicrobial use for Veterans receiving care at the rural VAMC. These dyads formed the Videoconference Antimicrobial Stewardship Teams or VASTs. VAST+ sites received a brief (2 page) Antibiotic Use Report that described summarized the antibiotic use at the rural VAMC acute care and CLC over the previous month, including a comparison to the average antibiotic use among other rural VAMCs in the same Medical Complexity Group. The Antibiotic Use Reports were distributed quarterly during the intervention period.

Other: Antibiotic Use Report

VAST -

NO INTERVENTION

Sites are rural VA Medical Centers that work with an ID physician at different VA to conduct regular discussions about infectious diseases and antimicrobial use for Veterans receiving care at the rural VAMC. These dyads formed the Videoconference Antimicrobial Stewardship Teams or VASTs. VAST- sites received no additional information about antibiotic use at their rural VAMC.

Interventions

Antibiotic Use Report OTHER

The Antibiotic Use Report uses both text and graphics to communicate successes and improvement opportunities specific to the VAMC for which it is prepared. The graphs summarize overall antibiotic use over the previous year, with additional information regarding use of broad- and narrow-spectrum agents. Further, each Antibiotic Use Report compares or "benchmarks" the individual VAMC for which it is prepared to other VAMCs in the same Medical Complexity Group. This approach adapts and expands peer comparison, which has proven effective at reducing inappropriate antibiotic use in outpatient settings.

VAST+

Eligibility Criteria

• Sex: all
• Healthy Volunteers: No
• Age Groups: Child (0-17), Adult (18-64), Older Adult (65+)

You may qualify if:

• VA medical centers without local ID expertise that pair with an ID-expert from another VA medical center.

You may not qualify if:

• (none)

Sponsors & Collaborators

• VA Office of Research and Development: lead

Study Sites (2)

Louis Stokes VA Medical Center, Cleveland, OH

Cleveland, Ohio, 44106-1702, United States

Location

VA Pittsburgh Healthcare System University Drive Division, Pittsburgh, PA

Pittsburgh, Pennsylvania, 15240, United States

Location

Related Publications (2)

• Fabre V, Davis A, Diekema DJ, Granwehr B, Hayden MK, Lowe CF, Pfeiffer CD, Sick-Samuels AC, Sullivan KV, Van Schooneveld TC, Morgan DJ. Principles of diagnostic stewardship: A practical guide from the Society for Healthcare Epidemiology of America Diagnostic Stewardship Task Force. Infect Control Hosp Epidemiol. 2023 Feb;44(2):178-185. doi: 10.1017/ice.2023.5.

  PMID: 36786646 BACKGROUND

• Jump RLP, Bej TA, Vivo A, Wilson BM, Kowal C, Song S, Abdelrahim S, Wilson G, Milner A, Nguyen A, Rodriguez KL, Beyer N, Michaels Z, Amundson C, Bajema KL, Beck A, Burnham JP, Crnich CJ, Drekonja DM, Epstein L, Ewers T, Livorsi DJ, Narayan M, Perez F, Pfeiffer CD, Sabzwari RW, Salti AM, Tate D, Walkner T, Webster AS, Evans CT. Dissemination and Implementation of a Telehealth-Enabled Program for Providing Infectious Disease Expertise in Rural Settings. Open Forum Infect Dis. 2025 Aug 11;12(8):ofaf485. doi: 10.1093/ofid/ofaf485. eCollection 2025 Aug.

  PMID: 40860515 RESULT

MeSH Terms

Conditions

Urinary Tract Infections; Pneumonia

Condition Hierarchy (Ancestors)

Infections; Urologic Diseases; Female Urogenital Diseases; Female Urogenital Diseases and Pregnancy Complications; Urogenital Diseases; Male Urogenital Diseases; Respiratory Tract Infections; Lung Diseases; Respiratory Tract Diseases

Limitations and Caveats

Not all the VASTs were robust or sustained. In general, those with a higher volume of consults tended to continue, sometimes connecting with an ID expert within the same VISN. Those with fewer cases may not have had sufficient volume to sustain engagement or did not cultivate the informal professional relationships that often facilitate trust and open communication. We elected to defer assessment of VAST on overall antibiotic use pending analysis of data from the sustainment period.

Results Point of Contact

• Title: Robin L. P. Jump, MD, PhD
• Organization: VA Pittsburgh Healthcare System

Robin.Jump@va.gov

412-360-2917

Study Officials

• Robin Lynn Paige Jump, MD PhD

  VA Pittsburgh Healthcare System University Drive Division, Pittsburgh, PA

  PRINCIPAL INVESTIGATOR

• Charlesnika Tyon Evans, PhD MPH BS

  Edward Hines Jr. VA Hospital, Hines, IL

  PRINCIPAL INVESTIGATOR

Publication Agreements

• PI is Sponsor Employee: Yes

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: HEALTH SERVICES RESEARCH
• Intervention Model: PARALLEL
• Sponsor Type: FED
• Responsible Party: SPONSOR

Model Details: The Practical, Robust Implementation and Sustainability Model (PRISM) is an expansion of the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) model. Briefly, PRISM expands RE-AIM to further consider key contextual factors related to implementation, evaluation and dissemination of health services programs. The investigators will use PRISM and RE-AIM to inform implementation, evaluation and maintenance of the intervention as the investigators seek to disseminate the VAST beyond the 2 pilot sites

Study Record Dates

• First Submitted: March 31, 2022
• First Posted: April 8, 2022
• Study Start: March 28, 2022
• Primary Completion: March 31, 2025
• Study Completion: March 31, 2026
• Last Updated: May 1, 2026
• Results First Posted: May 1, 2026

Record last verified: 2026-04

Data Sharing

• IPD Sharing: Will not share

Locations

US (2)