Standard vs. enhanced implementation strategies to increase adoption of a multidrug-resistant organism alert tool: a cluster randomized trial

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Background The Veterans Health Administration (VHA) launched VA Bug Alert (VABA) to identify admitted patients who are infected or colonized with multidrug-resistant organisms (MDROs) in real time and promote timely infection prevention measures. However, initial VABA adoption was suboptimal. The objective of this project was to compare the effectiveness of standard vs. enhanced implementation strategies for improving VABA adoption. Methods 121 VA healthcare facilities were evaluated for adoption of VABA (at least 1 user registered at a facility) April 2021–September 2022. All facilities initially received standard implementation, which included: VABA revisions based on end-user feedback, education, and internal facilitation via monthly meetings with the MDRO Prevention Division of the VHA National Infectious Diseases Service. Surveys evaluated VABA perspectives among MDRO Prevention Coordinators (MPCs) and/or Infection Preventionists (IPs) before and after initial standard implementation. Facilities not registered for VABA following initial standard implementation (n = 31) were cluster-randomized to continue to receive standard implementation or enhanced implementation (audit and feedback reports and external facilitation via guided interviews to assess VABA use barriers). Percentages of facilities adopting VABA at baseline, after standard implementation (Follow-up 1), and after the enhanced vs. standard implementation trial period (Follow-up 2) were assessed and compared across time points using McNemar’s test. VABA adoption was compared by trial condition using Fisher's exact test. Results Before education, 25% of 167 MPC/IP survey respondents across 116 facilities reported no knowledge/use of VABA. After education, 82% of 92 survey respondents across 80 facilities reported intending to use VABA. At baseline, VABA registrations were 40%. Registrations significantly increased aft Follow-up 1(75%, p < 0.01) and at Follow-up 2 (89%, p < 0.01). Adoption did not significantly differ by assigned implementation condition but was higher among facilities that completed all components of enhanced implementation than those who did not (87.5% vs. 43.5%, p = 0.045). Guided interviews revealed key facilitators of VABA registration, which included perceived fit, implementation activities, and organizational context (e.g., staffing resources). Conclusions Implementation efforts dramatically increased VABA registrations. Incorporating interview feedback to increase VABA's fit with users' needs may increase its use and help reduce MDRO spread in VA.

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