697. Effects of Policy and Resources on Antimicrobial Stewardship Interventions in the VA: Applying a Transaction Cost Economics Framework
Session: Poster Abstract Session: Stewardship: Data and Program Planning
Thursday, October 5, 2017
Room: Poster Hall CD
  • IDWK 2017 Poster_ASP Policy_Chou.pdf (181.8 kB)
  • Background: Inappropriate antimicrobial use poses a serious threat to patient safety. Various antimicrobial stewardship interventions (ASI) have been proposed to optimize antimicrobial use and improve patient outcomes, but ASI implementation remains an organizational challenge. This study examines associations between policy and resources and ASI implementation/uptake in VA facilities.

    Methods: Implementing new practices requires changes in organizational structure, culture, and work. As ASIs require coordination among staff and activities, the transaction cost economics (TCE) perspective is used to examine ASI uptake. TCE dimensions describe: (1) uncertainty; (2) frequency of interactions; and (3) asset specificity. Using a cross sectional design, surveying 140 VA facilities in 2015, outcomes examined were: (1) facility tracking 3 or more ASIs; and (2) barriers to optimal antimicrobial use. Independent variables include those describing site specificity, resources, and various AS policies as proxies for uncertainty. Multivariable logistic regressions with Least Absolute Shrinkage and Selection Operator approach was used to identify the subset of variables and generate odds ratios across TCE dimensions associated with ASI uptake.

    Results: Infectious disease attendings in medical wards, clinical pharmacists assigned to teams, documentation of indication in medical record/order entry, policies on intravenous to oral conversion, electronic tools were associated with greater ASI uptake. Similar variables also decreased the likelihood of facilities experiencing barriers to optimal antibiotic use.

    Conclusion: Overall, site specificity, human resources, physical assets, and policies facilitated ASI uptake and ameliorated barriers to optimal antimicrobial use. These variables represent mechanisms that improved efficiencies of coordination and provided resources to achieve stewardship goals. ASI uptake represents a complex change, requiring a system-wide response. The TCE framework is useful to inform facilities in their strategies to adopt new ways of organizing in order to manage emerging demands of changing clinician work, coordinate across units/departments, and develop tools to optimize antimicrobial use.

    Ann Chou, PhD, MPH, Family and Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, Yue Zhang, PhD, Division of Epidemiology, Department of Medicine, University of Utah, Salt Lake City, UT, Makoto Jones, MD, MS, Internal Medicine, VA Salt Lake City Health Care System, Salt Lake City, UT, Christopher J. Graber, MD, MPH, FIDSA, Infectious Diseases Section, VA Greater Los Angeles Healthcare System, Los Angeles, CA, Matthew Goetz, MD, Infectious Diseases, VA Greater Los Angeles Healthcare System, Los Angeles, CA, Karl Madaras-Kelly, PharmD, M.P.H., Clinical Pharmacy, College of Pharmacy, Idaho State University and VA Medical Center, Boise, ID, Matthew Samore, MD, FSHEA, University of Utah School of Medicine, Division of Epidemiology, Salt Lake City, UT, Allison Kelly, MD, MSOH, Internal Medicine/Infectious Diseases, University of Cincinnati College of Medicine, Cincinnati, OH and Peter Glassman, MBBS, MSc, David Geffen School of Medicine at UCLA, Los Angeles, CA


    A. Chou, None

    Y. Zhang, None

    M. Jones, None

    C. J. Graber, None

    M. Goetz, None

    K. Madaras-Kelly, None

    M. Samore, None

    A. Kelly, None

    P. Glassman, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 4th with the exception of research findings presented at the IDWeek press conferences.