CIRAR Research Team Retreat
June 9, 2005

.pdf DOWNLOADS:
|  Agenda  |
|  Aims  |
|  Summary  |

Ideas from break-out group discussions:

• Prevent infection by changing behaviors – consumer knowledge and behavior
  • How do consumers get their knowledge
  • How accurate is their knowledge
  • How does the knowledge affect them
  • Perception of risk and how influences empiric use of AB
  • What interface will improve knowledge (provider/patient relations)
  • Possible R01 to improve knowledge of AR; how measure intervention?
  • Considerations: intervention in hospital, bodegas, vulnerable populations (HIV), informatics, social network analysis & implementing guidelines, algorithms, risk perception model, cultural, dissemination diffusion model
• Computer guideline for point of care – using ventilator-associated pneumonia
  • Use of alerts/reminders with guidelines imbedded as well as outpatient guidelines for knowing how to treat illness
  • Need to flesh out how to measure compliance with guidelines
  • Theoretical models- technology acceptance model, theory of reasoned action (user must perceive technology to be useful, product of value), information processing theory, comprehension theory, social cognitive theory (guideline comprehension)

Diagnostic tool for ICU – using ventilator-associated pneumonia Develop tool related more to diagnostics as opposed to one that is analytic For providers to use at the point of care, for ex guidelines to ventilator-associated pneumonia, appropriate prescribing & decreasing length of use Scoring system for patients at risk Analyze how integrate with micro/informatics, rapid diagnostics, isolation, algorithms with interpretation so can revise if not adequate

• Social networking analysis
  • Guidelines written but not used or diffused in hospital/general population
  • How prevention messages diffuse and are used in ICUs – track diffusion and integration (U of Chicago reference)
  • Use AB guidelines and interdisciplinary teams in ICU and look at prescribing patterns, how guidelines implemented and how can improve
  • Under what circumstances does it diffuse (educate how many and who?)
  • Can be experimental study and/or descriptive
  • Tie in surveillance (possibly link with Kukafka’s work with NYCDOH & Center for Public Health Informatics), informatics as feedback
  • Considerations: herd immunity/tipping point, epidemiology, lab sciences, behavioral sciences, informatics
• If a person is treated inappropriately vs appropriately, how affect outcomes?
  • What is probability of developing AM resistance
  • Can look retrospectively, if someone comes in with AM resistant bug, look back at history to see if treated appropriately/inappropriately
  • Modeling component, route-cause analysis
  • Can use framework of 12 Steps Program – diagnose and treat effectively in accordance with local known epidemiology
  • Hospital vs. community transmission
• Diagnose and treat effectively – using hospital ventilator-associated pneumonia
  • When patient admitted to ICU, screen by rapid diagnostics for resistant organisms that would put them at increased risk for infection
  • Conduct intervention using information technology, SWAT team, personal protective equipment, preventative strategies
  • Cost effective analysis and policy implementation (payment to hospital, optimal alternative interventions, incentives)
  • Can apply to other device related infections (catheter, BSI)
  • Surveillance strategies & rapid diagnostics, allow to intervene more rapidly – cost effective analysis, bed transfers avoided, transmission, etc

Research interest groups: 1.  ICU / Screening / SWAT Team / Lisa Saiman and Sherry Glied: co-team leads Yoko Furuya, Phyllis Della-Latta 2.  Guidelines / Informatics / Practitioner Behavior / Leanne Currie, Yoko Furuya, Elaine Larson, Aaron Schwartz 3.  Consumer & Provider Behavior Rita Kukafka, Suzanne Bakken 4.  Risk Groups / Social Networks / Maureen Miller, Frank Lowy 5.  Modeling – hospital, community, social externalities & networks, cost effectiveness Sherry Glied and contact (Josh)    6.  Rapid diagnostics / shared grant (P30) Phyllis Della-Latta, Richard Huard