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Assessing hospital antibiotic stewardship program (ASP) implementation: validation of an implementation

Jorie Michaela Butler1,2,3,4, Ellen Childs5, Tamar Barlam6

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Summary

This study developed a valid survey for antibiotic stewardship programs (ASPs) using the Consolidated Framework for Implementation Research (CFIR). The survey helps identify factors influencing ASP success and allows comparisons across healthcare settings.

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Area of Science:

  • Implementation Science
  • Health Services Research
  • Infectious Diseases

Background:

  • Antibiotic stewardship programs (ASPs) are vital for combating antibiotic resistance and enhancing patient care.
  • A validated tool is needed to understand ASP implementation and facilitate cross-site comparisons.

Purpose of the Study:

  • To develop and validate a survey instrument based on the Consolidated Framework for Implementation Research (CFIR) to assess determinants of antibiotic stewardship program implementation.
  • To evaluate the psychometric properties of the developed survey.

Main Methods:

  • Recruited infectious disease pharmacists and physicians from Veterans Affairs (VA) hospitals to complete a survey.
  • Developed the survey based on the CFIR, assessing 22 implementation determinants across five CFIR domains.
  • Conducted confirmatory factor analyses (CFA) and evaluated internal consistency (Cronbach's alpha).

Main Results:

  • 150 stewards from 110 VA hospitals completed the survey.
  • CFA demonstrated good fit for most CFIR constructs, with internal consistency ranging from 0.54-0.96.
  • Key determinants positively perceived included Self-Efficacy, Engaging, Evidence Strength and Quality, and Relative Advantage.

Conclusions:

  • The CFIR-based survey is a valid instrument for assessing determinants of antibiotic stewardship program implementation outcomes.
  • This tool can assist clinical, quality improvement, and research teams in identifying implementation barriers and facilitators.
  • The survey enables strategic planning and facilitates comparisons of ASP implementation across different sites.