Survey of VA healthcare facilities to assess organizational readiness to change assessment (ORCA) and challenges to implementing antibiotic stewardship
Introduction: Prior to implementing a multisite antibiotic stewardship intervention for asymptomatic bacteriuria, we performed the organizational readiness to change assessment (ORCA) and an antibiotic stewardship challenges survey. We hypothesized that facility complexity would be related to organi...
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Elsevier
2025-06-01
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| Series: | CMI Communications |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2950590925000162 |
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| author | Tyler J. Brehm Eva Amenta Larissa Grigoryan Sophia Braund Jonah Pesikoff Rogelio Hernandez David Ramsey Vanessa W. Stevens John P. Donnelly Aanand D. Naik Barbara W. Trautner |
| author_facet | Tyler J. Brehm Eva Amenta Larissa Grigoryan Sophia Braund Jonah Pesikoff Rogelio Hernandez David Ramsey Vanessa W. Stevens John P. Donnelly Aanand D. Naik Barbara W. Trautner |
| author_sort | Tyler J. Brehm |
| collection | DOAJ |
| description | Introduction: Prior to implementing a multisite antibiotic stewardship intervention for asymptomatic bacteriuria, we performed the organizational readiness to change assessment (ORCA) and an antibiotic stewardship challenges survey. We hypothesized that facility complexity would be related to organizational readiness to change and perceived challenges to antibiotic stewardship. Methods: ORCA and antibiotic stewardship challenges surveys were conducted at 40 Veterans Health Administration (VHA) medical centers (inpatient acute and long-term care). VHA healthcare facility complexity ranges from level 1 (high) to level 3 (low) based on volume and acuity of care. Mean Likert scores were calculated for each ORCA subscale. We compared survey results for complexity level 3 sites versus combined complexity level 1 and 2 sites. Results: 30 VHA sites completed at least 3 ORCA surveys and were included for analysis (n = 202 surveys). Overall ORCA scores were significantly lower at level 3, least complex, facilities compared to levels 1 and 2 (P = 0.046). Level 3 facilities reported significantly more antibiotic stewardship challenges (median = 10, interquartile range [IQR] = 4.5–11.2) versus levels 1 and 2 (median = 3, IQR 2.0–5.7, P = 0.004). Level 3 facilities also reported significantly lower provider/prescriber buy-in (P = 0.005), microbiology resources (P = 0.009), and stewardship or infectious diseases subject matter expertise (P = 0.003). Conclusion: In a national sample, low complexity sites reported a lower readiness to change and perceived a higher number of antibiotic stewardship challenges. Less complex healthcare facilities may have fewer resources overall, decreasing their readiness to implement antibiotic stewardship interventions. |
| format | Article |
| id | doaj-art-106e1b028a6a4013b20fd0f02180969c |
| institution | DOAJ |
| issn | 2950-5909 |
| language | English |
| publishDate | 2025-06-01 |
| publisher | Elsevier |
| record_format | Article |
| series | CMI Communications |
| spelling | doaj-art-106e1b028a6a4013b20fd0f02180969c2025-08-20T03:24:00ZengElsevierCMI Communications2950-59092025-06-012210507410.1016/j.cmicom.2025.105074Survey of VA healthcare facilities to assess organizational readiness to change assessment (ORCA) and challenges to implementing antibiotic stewardshipTyler J. Brehm0Eva Amenta1Larissa Grigoryan2Sophia Braund3Jonah Pesikoff4Rogelio Hernandez5David Ramsey6Vanessa W. Stevens7John P. Donnelly8Aanand D. Naik9Barbara W. Trautner10Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA; Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, TX, USA; Corresponding author at: 2002 Holcombe Blvd (152), Houston, TX 77030, USA.Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA; Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, TX, USACenter for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA; Department of Family & Community Medicine, Baylor College of Medicine, Houston, TX, USATilman J. Fertitta Family College of Medicine, University of Houston, Houston, TX, USACenter for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USACenter for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USACenter for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA; Department of Medicine, Section of Health Services Research, Baylor College of Medicine, Houston, TX, USAVA Salt Lake Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center, VA Salt Lake City Health Care System, Salt Lake City, UT, USA; Department of Internal Medicine, Division of Epidemiology, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT, USADepartment of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, MI, USA; VA HSR Center for Clinical Management Research, Ann Arbor, MI, USA; VA QUERI Center for Evaluation and Implementation Resources, Ann Arbor, MI, USADepartment of Management, Policy and Community Health, University of Texas School of Public Health, Houston, TX, USA; UTHealth Institute on Aging, University of Texas Health Science Center, Houston, TX, USACenter for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA; Department of Medicine, Section of Health Services Research, Baylor College of Medicine, Houston, TX, USAIntroduction: Prior to implementing a multisite antibiotic stewardship intervention for asymptomatic bacteriuria, we performed the organizational readiness to change assessment (ORCA) and an antibiotic stewardship challenges survey. We hypothesized that facility complexity would be related to organizational readiness to change and perceived challenges to antibiotic stewardship. Methods: ORCA and antibiotic stewardship challenges surveys were conducted at 40 Veterans Health Administration (VHA) medical centers (inpatient acute and long-term care). VHA healthcare facility complexity ranges from level 1 (high) to level 3 (low) based on volume and acuity of care. Mean Likert scores were calculated for each ORCA subscale. We compared survey results for complexity level 3 sites versus combined complexity level 1 and 2 sites. Results: 30 VHA sites completed at least 3 ORCA surveys and were included for analysis (n = 202 surveys). Overall ORCA scores were significantly lower at level 3, least complex, facilities compared to levels 1 and 2 (P = 0.046). Level 3 facilities reported significantly more antibiotic stewardship challenges (median = 10, interquartile range [IQR] = 4.5–11.2) versus levels 1 and 2 (median = 3, IQR 2.0–5.7, P = 0.004). Level 3 facilities also reported significantly lower provider/prescriber buy-in (P = 0.005), microbiology resources (P = 0.009), and stewardship or infectious diseases subject matter expertise (P = 0.003). Conclusion: In a national sample, low complexity sites reported a lower readiness to change and perceived a higher number of antibiotic stewardship challenges. Less complex healthcare facilities may have fewer resources overall, decreasing their readiness to implement antibiotic stewardship interventions.http://www.sciencedirect.com/science/article/pii/S2950590925000162Organizational readiness to changeAntibiotic stewardshipHealthcare facility complexityVeterans affairsAsymptomatic bacteriuria |
| spellingShingle | Tyler J. Brehm Eva Amenta Larissa Grigoryan Sophia Braund Jonah Pesikoff Rogelio Hernandez David Ramsey Vanessa W. Stevens John P. Donnelly Aanand D. Naik Barbara W. Trautner Survey of VA healthcare facilities to assess organizational readiness to change assessment (ORCA) and challenges to implementing antibiotic stewardship CMI Communications Organizational readiness to change Antibiotic stewardship Healthcare facility complexity Veterans affairs Asymptomatic bacteriuria |
| title | Survey of VA healthcare facilities to assess organizational readiness to change assessment (ORCA) and challenges to implementing antibiotic stewardship |
| title_full | Survey of VA healthcare facilities to assess organizational readiness to change assessment (ORCA) and challenges to implementing antibiotic stewardship |
| title_fullStr | Survey of VA healthcare facilities to assess organizational readiness to change assessment (ORCA) and challenges to implementing antibiotic stewardship |
| title_full_unstemmed | Survey of VA healthcare facilities to assess organizational readiness to change assessment (ORCA) and challenges to implementing antibiotic stewardship |
| title_short | Survey of VA healthcare facilities to assess organizational readiness to change assessment (ORCA) and challenges to implementing antibiotic stewardship |
| title_sort | survey of va healthcare facilities to assess organizational readiness to change assessment orca and challenges to implementing antibiotic stewardship |
| topic | Organizational readiness to change Antibiotic stewardship Healthcare facility complexity Veterans affairs Asymptomatic bacteriuria |
| url | http://www.sciencedirect.com/science/article/pii/S2950590925000162 |
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