Peter Taber1, Charlene Weir2, Jorie M Butler3, Christopher J Graber4, Makoto M Jones5, Karl Madaras-Kelly6, Yue Zhang5, Ann F Chou7, Matthew H Samore5, Matthew Bidwell Goetz4, Peter A Glassman8. 1. Department of Biomedical Informatics, University of Utah, Salt Lake City, UT. Electronic address: peter.taber@hsc.utah.edu. 2. Department of Biomedical Informatics, University of Utah, Salt Lake City, UT; IDEAS Center, VA Salt Lake City Healthcare System, Salt Lake City, UT. Electronic address: charlene.weir@utah.edu. 3. Department of Biomedical Informatics, University of Utah, Salt Lake City, UT; IDEAS Center, VA Salt Lake City Healthcare System, Salt Lake City, UT; Geriatric Education and Clinical Center, VA Salt Lake City Healthcare System, Salt Lake City, UT; Department of Medicine, University of Utah, Salt Lake City, UT. 4. Center for Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA; Department of Medicine, David Geffen School of Medicine at the University of California-Los Angeles, Los Angeles, CA; Infectious Diseases Section, VA Greater Los Angeles Healthcare System, Los Angeles, CA. 5. IDEAS Center, VA Salt Lake City Healthcare System, Salt Lake City, UT; Geriatric Education and Clinical Center, VA Salt Lake City Healthcare System, Salt Lake City, UT; Division of Epidemiology, University of Utah, Salt Lake City, UT. 6. Department of Pharmacy Boise VA Medical Center, Boise, ID; College of Pharmacy, Idaho State University, Meridian, ID. 7. Department of Family and Preventive Medicine, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK. 8. Center for Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA; VA Pharmacy Benefits Management Services, Department of Veterans Affairs, Washington, DC; Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, CA.
Abstract
OBJECTIVE: To evaluate antimicrobial stewards' experiences of using a dashboard display integrating local and national antibiotic use data implemented in the U.S. Department of Veterans Affairs (VA). This paper reports early formative evaluation. DESIGN: Qualitative interviewing. SETTING: Eight VA hospitals participated with established antimicrobial stewardship (AS) programs participated in the pilot. PARTICIPANTS: Six infectious disease physicians and eight clinical pharmacists agreed to be interviewed (n = 14). METHODS: A 3-part qualitative interview script was used involving a description of local stewardship activities, a Critical Incident description of dashboard use, and general questions regarding attitudes towards the tool. An inductive open coding approach was used for analysis. RESULTS: We found 4 themes showing the complexities of using stewardship tools: (1) Data validity is socially negotiated; (2) Performance feedback motivates and persuades social goals when situated in an empirical distribution; (3) Shared problem awareness is aided by authoritative data; and (4) The AS dashboard encourages connections with local quality improvement culture. CONCLUSIONS: Social dimensions of AS tool use emerged as distinct from, and equally important as decision support provided by the dashboard. Successful stewardship tools should be designed to support both the social and cognitive needs of users.
OBJECTIVE: To evaluate antimicrobial stewards' experiences of using a dashboard display integrating local and national antibiotic use data implemented in the U.S. Department of Veterans Affairs (VA). This paper reports early formative evaluation. DESIGN: Qualitative interviewing. SETTING: Eight VA hospitals participated with established antimicrobial stewardship (AS) programs participated in the pilot. PARTICIPANTS: Six infectious disease physicians and eight clinical pharmacists agreed to be interviewed (n = 14). METHODS: A 3-part qualitative interview script was used involving a description of local stewardship activities, a Critical Incident description of dashboard use, and general questions regarding attitudes towards the tool. An inductive open coding approach was used for analysis. RESULTS: We found 4 themes showing the complexities of using stewardship tools: (1) Data validity is socially negotiated; (2) Performance feedback motivates and persuades social goals when situated in an empirical distribution; (3) Shared problem awareness is aided by authoritative data; and (4) The AS dashboard encourages connections with local quality improvement culture. CONCLUSIONS: Social dimensions of AS tool use emerged as distinct from, and equally important as decision support provided by the dashboard. Successful stewardship tools should be designed to support both the social and cognitive needs of users.
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