Dissemination and implementation of a telehealth program to deliver effective antibiotic stewardship support to rural or medically underserved newborn nurseries.

PROJECT ABSTRACT __ Antibiotic exposure in newborns is associated with significant morbidity and mortality, including infection with antibiotic-resistant organisms, asthma, obesity, metabolic syndrome, and diabetes among others. Despite this, antibiotics are misused in neonates at alarming rates and remain the most-prescribed medications in the nursery. Antibiotic stewardship programs (ASPs) can significantly reduce antibiotic exposure but require specialist support to be effective. Like many evidence-based interventions, a gap remains between research and widespread implementation. Most well-baby nurseries – particularly those in rural or medically underserved areas – do not have access to ASP support, which is a major health disparity. Scalable approaches to increase implementation of evidence-based practices, such as ASPs, are needed to address such disparities. Telehealth has been used successfully to deliver other aspects of newborn care, such as complex care coordination and health screening. Telehealth strategies have been used in adult and pediatric ASP efforts, and telehealth for infectious diseases support has been endorsed by the Infectious Diseases Society of America. Our preliminary study, ASSIST-1, was the first to utilize telehealth to deliver ASP support specifically for newborn nurseries. The ASSIST-1 study of 8 rural nurseries showed that telehealth ASP was safe and effective, reducing unnecessary antibiotic use by 32%. In this R18 health services research demonstration and dissemination grant, we aim to use dissemination and implementation (D&I) science to accelerate delivery of our evidence-based telehealth ASP to additional level 1 and 2 nurseries (N=40) in rural or medically underserved areas throughout Texas. Our hypothesis is that nursery telehealth is a scalable approach to increase access to infectious diseases care and reduce unnecessary antibiotic exposure among newborns born in medically underserved areas. We will test our hypothesis using an effectiveness- implementation hybrid type 2 design based on the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) and Consolidated Framework for Implementation Research (CFIR) models to measure uptake, efficacy, and sustainability of the telehealth ASP. Our specific aims are to evaluate (1) the adoption, (2) the effectiveness, cost, and value, and (3) the maintenance and sustainability of the telehealth ASP. The study team includes content experts in neonatal infectious diseases (Drs. Cantey and Duchon), D&I science (Drs. Stevens and Kilpela), and patient-centered outcomes and cost-effectiveness research (Dr. Tsevat). The proposed research is innovative in its use of telehealth strategies to link rural hospitals with pediatric infectious diseases specialists, improve care for infants with suspected or proven infection, and minimize adverse effects of unnecessary antibiotic exposure. In addition, successful implementation of our study could subsequently serve as the platform for linking rural nurseries to other pediatric subspecialists, thus relieving access-to-care disparities and improving the quality, equity, and value of care for infants born in medically underserved areas.