Haltom Trenton M, Braund Sophia, Hernandez Rogelio, Grigoryan Larissa, Trautner Barbara W, Amenta Eva
Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey VA Medical Center, Houston, TX, USA.
Department of Medicine, Section of Health Services Research, Baylor College of Medicine, Houston, TX, USA.
Antimicrob Steward Healthc Epidemiol. 2025 May 26;5(1):e118. doi: 10.1017/ash.2025.63. eCollection 2025.
Overtreatment of asymptomatic bacteriuria (ASB) is a major cause of antibiotic overuse. We facilitated a nationwide implementation of an ASB antimicrobial stewardship intervention in 41 Veterans Affairs facilities. Twenty-one sites participated in a Virtual Learning Collaborative (VLC) with monthly webinars. We assess what VLC teams learned from one another in these webinars.
The bi-monthly VLC webinars featured expert presentations and spotlighted 1-2 site teams, asking them to discuss their barriers and facilitators for the intervention. Data come from analyses of descriptive field notes from the webinars and chat transcripts. Field notes were analyzed using the "sort and sift, think and shift" method. We sorted and labeled common strategies thematically, sifted through illustrative quotes, and iteratively discussed the results to reach consensus.
Across 22 webinars (August 2023-April 2024), sites discussed different resources, team membership, and organizational structures. Sites had to "tailor swiftly" to their site needs and target audiences by adapting educational materials for timing, length, audience, and outreach location. Sites used five tailoring strategies to implement the antimicrobial stewardship program: Organizational and Structural Strategies, Recruitment Strategies, Data- and Information-Based Strategies, Interpersonal Strategies, and Resource Provision.
VLC webinars allowed sites to share tips and strategies for the implementation of a nationwide antimicrobial stewardship program wherein rapid tailoring and local adaptations were effective. Our supportive approach to tailoring allowed implementation sites to adapt antimicrobial stewardship materials and intervention delivery to their different resources and organizational contexts.
无症状菌尿（ASB）的过度治疗是抗生素过度使用的主要原因。我们在41个退伍军人事务机构推动了一项全国性的ASB抗菌药物管理干预措施。21个地点参加了虚拟学习协作（VLC），每月举办网络研讨会。我们评估VLC团队在这些网络研讨会上相互学到了什么。
每两个月举办一次的VLC网络研讨会以专家讲座为特色，并重点介绍1-2个地点的团队，要求他们讨论干预措施的障碍和促进因素。数据来自对网络研讨会的描述性现场记录和聊天记录的分析。现场记录采用“分类筛选、思考转变”的方法进行分析。我们按主题对常见策略进行分类和标记，筛选出说明性引语，并反复讨论结果以达成共识。
在22次网络研讨会（2023年8月至2024年4月）中，各地点讨论了不同的资源、团队成员和组织结构。各地点必须根据自身需求和目标受众“迅速调整”，通过调整教育材料的时间、长度、受众和推广地点。各地点采用了五种调整策略来实施抗菌药物管理计划：组织和结构策略、招募策略、基于数据和信息的策略、人际策略和资源提供。
VLC网络研讨会使各地点能够分享在全国范围内实施抗菌药物管理计划的技巧和策略，其中快速调整和因地制宜是有效的。我们支持性的调整方法使实施地点能够根据其不同的资源和组织背景调整抗菌药物管理材料和干预措施的实施方式。
