# Dissemination and Implementation of a Videoconference Antimicrobial Stewardship Team (VAST)

> **NIH VA I01** · EDWARD HINES JR VA HOSPITAL · 2023 · —

## Abstract

Background: Antimicrobial-resistant and healthcare-associated pathogens are a serious threat in the United
States, accounting for over 3 million infections each year. Antimicrobial stewardship remains the strongest tool
in reducing the over prescribing of antibiotics, the leading modifiable cause of resistance. Despite this,
inappropriate antibiotic use is still common in the VA. Furthermore, little is known about the role health
disparities play in antibiotic inappropriate antibiotic prescribing.
Significance: This proposal is highly significant for Veterans and the goals of VA. Previous studies have
shown that additional antimicrobial stewardship efforts are needed in VA outpatient settings. Additionally, this
project will provide evidence on health disparities and system factors that can be targeted in interventions to
improve VA outpatient antibiotic prescribing. This project is aligned with the priorities of our operation partners:
the VA Antimicrobial Stewardship Task Force and the Office of Rural Health.
Specific Aims: The goal of this proposal will be to evaluate the patient and system factors that drive
inappropriate antibiotic prescribing at the Videoconferencing Antimicrobial Stewardship Team (VAST) study
sites using integrated health disparities and antimicrobial stewardship frameworks. Aim 1: Determine the
percentage of antibiotic over-prescribing and under-prescribing for acute respiratory infections that occur by
Veteran's race/ethnicity in VAST sites. Aim 2: Determine the percentage of antibiotic over-prescribing and
under-prescribing by Veteran's race/ethnicity for urinary tract infections in VAST sites. Aim 3: Explore the
system factors that predict the rate of over/under prescription of antibiotics by race/ethnicity.
Methodology: For Aim 1, a retrospective cohort design will include outpatients from the 16 VAST study sites
with a diagnosis of acute respiratory infection. The percentage of over-prescribing, and under-prescribing will
be determined using criteria from clinical practice guidelines. Multinomial logistic regression models will
determine the likelihood of patients correctly treated, over, or under-prescribed antibiotics by race/ethnicity. For
Aim 2, a randomly selected sample of outpatients presenting with a urinary tract infection will be examined
using electronic medical reviews to determine whether the diagnosis and treatment of urinary tract infection
was appropriate according to clinical practice guidelines. The ratio of appropriately diagnosed and prescribed
events will be evaluated by race/ethnicity. Aim 3 will use the same cohorts described in Aims 1 & 2 to
determine the difference in antibiotic prescribing practices by system factors. Hierarchical logistic regression
models will determine the likelihood of patients being over or under-prescribed antibiotics.
Candidate Background: Dr. Wilson has been a Research Health Scientist with the Center of Innovation for
Complex Chronic Healthcare (CINCCH) at Edward Hi...

## Key facts

- **NIH application ID:** 10672768
- **Project number:** 3I01HX003364-01A1S1
- **Recipient organization:** EDWARD HINES JR VA HOSPITAL
- **Principal Investigator:** CHARLESNIKA T EVANS
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2023
- **Award amount:** —
- **Award type:** 3
- **Project period:** 2022-10-01 → 2024-09-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10672768

## Citation

> US National Institutes of Health, RePORTER application 10672768, Dissemination and Implementation of a Videoconference Antimicrobial Stewardship Team (VAST) (3I01HX003364-01A1S1). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10672768. Licensed CC0.

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