Schweizer to identify a smarter culture “culture”

Marin Schweizer, PhD, Associate Professor in General Internal Medicine and of Epidemiology, has been awarded a three-year, $959,440 Merit Award, as part of the VA’s HSR&D Investigator-Initiated Research program. Dr. Schweizer will use this grant to study how best to reduce unnecessary testing and prescription of antibiotics. She and her co-investigator, Dr. Kalpana Gupta, a researcher at the Boston VA, will look specifically at antimicrobial stewardship for asymptomatic bacteriuria (ASB) among surgical patients.

As with her other VA Merit Award, Dr. Schweizer is looking to de-implement an all-too-common clinical practice that has little evidence to support its use. At the time of that grant’s award, Dr. Schweizer recognized the challenge ahead: “It is harder to scale back current medical practices than it is to implement a new practice.” But that challenge has not dissuaded her from finding new fronts for the effort to prescribe antibiotics more sensibly.

Often surgical patients without UTI symptoms have urine cultures performed and antibiotics prescribed on “false positive” results, despite new guidelines from national societies to only prescribe when symptoms are present. “Overuse of antibiotics can lead to preventable harms,” Dr. Schweizer said, “like C. difficile infection or antibiotic resistance, without any benefit.”

Under this grant, Dr. Schweizer’s team will first conduct a retrospective national cohort study to find important factors connected to urine testing and ASB treatment. By interviewing providers at five different institutions, she and her team hope to identify the barriers to change as well as the best possible procedures that will make positive change persist. (This search for “provider buy-in” is a method that Dr. Schweizer has previously found successful.)

Once the analysis and interviews are complete, Dr. Schweizer and her team will develop and pilot a tool that will be used at five VA hospitals. These institutions are part of a network of sites within the Centers for Disease Control and Prevention and VA CREATE network, a CADRE initiative under the leadership of Drs. Eli Perencevich and Heather Reisinger. As with many of the HSR&D programs, the ultimate goal of the project will be to introduce a set of recommendations that can be put into practice in hospitals nationwide.