# Improving antimicrobial use at hospitals that lack infectious disease specialists

> **NIH VA IK2** · IOWA CITY VA MEDICAL CENTER · 2020 · —

## Abstract

The primary goal of this application is to foster the development of Dr. Daniel Livorsi as
an independent VHA investigator devoted to improving antimicrobial-prescribing across the
continuum of healthcare. This application specifically focuses on optimizing the performance of
antimicrobial stewardship programs (ASPs) in resource-limited settings.
 ASPs are hospital-based programs that ensure patients receive the right antimicrobial at
the right dose and for the right duration. These programs have proven benefits, such as
improving patient safety and reducing antimicrobial resistance. ASPs are now mandated in
every VHA facility and will soon be required in non-VHA hospitals as well. The widespread
implementation of robust ASPs is essential for addressing the crisis of antimicrobial resistance.
 Though necessary, widespread ASP implementation will be challenging. Many ASPs
lack access to Infectious Disease (ID) specialists—including 23% of VHA-ASPs—and it is
unclear how ASPs can be effective in such resource-limited settings. This application will begin
to address this problem through an ambitious but achievable Research Plan.
 Project 1 will analyze antimicrobial use data from across the VHA. Multivariable analysis
will be used to identify structural and process factors associated with optimal facility-level ASP
performance, as measured by facility antimicrobial usage (primary outcome) and 7 secondary
metrics. The goal is to identify processes that work for ASPs even in the absence of ID
pharmacists and ID physicians. Facilities will also be ranked on the risk-adjusted primary
outcome; high and low performers will be identified. Project 2 will use qualitative research
methods to determine provider attitudes and organizational factors that impede or foster
antimicrobial stewardship at 8 VHA hospitals with ASPs lacking ID support. For this project, the
team will conduct research at 4 low-performing and 4 high-performing facilities, as determined
by performance on the primary outcome. Project 3 will synthesize the findings from Projects 1
and 2 to develop pilot improvement strategies for low-performing ASPs that lack ID support. The
model of Physician Mentored Implementation will guide this intervention, and a pretest-posttest
design will be used to assess the effect of the intervention at the 2 intervention hospitals
compared to 2 control hospitals.
 In addition to the above Research Plan, this application proposes integrated Career
Development activities that build on Dr. Livorsi’s expertise in leading ASPs and his prior
experience with qualitative assessments and secondary data analysis. These career
development activities have the following objectives: 1) gaining fluency in the analysis of
national VHA databases and the use of multilevel regression models; 2) building expertise in
implementation science with a focus on qualitative assessments; and 3) developing proficiency
in the conduct and analysis of multicenter interventions.
 These Research ...

## Key facts

- **NIH application ID:** 10175014
- **Project number:** 5IK2HX002281-03
- **Recipient organization:** IOWA CITY VA MEDICAL CENTER
- **Principal Investigator:** Daniel Livorsi
- **Activity code:** IK2 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2020
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2017-10-01 → 2022-09-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10175014

## Citation

> US National Institutes of Health, RePORTER application 10175014, Improving antimicrobial use at hospitals that lack infectious disease specialists (5IK2HX002281-03). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10175014. Licensed CC0.

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