Structural and process factors affecting the implementation of antimicrobial resistance prevention and control strategies in U.S. hospitals

Ann F. Chou, Elizabeth M. Yano, Kimberly D. McCoy, Deanna Willis, Bradley N. Doebbeling

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Background: To address increases in the incidence of infection with antimicrobial-resistant pathogens, the National Foundation for Infectious Diseases and Centers for Disease Control and Prevention proposed two sets of strategies to (a) optimize antibiotic use and (b) prevent the spread of antimicrobial resistance and control transmission. However, little is known about the implementation of these strategies. Purpose: Our objective is to explore organizational structural and process factors that facilitate the implementation of National Foundation for Infectious Diseases/Centers for Disease Control and Prevention strategies in U.S. hospitals. Methods: We surveyed 448 infection control professionals from a national sample of hospitals. Clinically anchored in the Donabedian model that defines quality in terms of structural and process factors, with the structural domain further informed by a contingency approach, we modeled the degree to which National Foundation for Infectious Diseases and Centers for Disease Control and Prevention strategies were implemented as a function of formalization and standardization of protocols, centralization of decision-making hierarchy, information technology capabilities, culture, communication mechanisms, and interdepartmental coordination, controlling for hospital characteristics. Findings: Formalization, standardization, centralization, institutional culture, provider-management communication, and information technology use were associated with optimal antibiotic use and enhanced implementation of strategies that prevent and control antimicrobial resistance spread (all p < .001). However, interdepartmental coordination for patient care was inversely related with antibiotic use in contrast to antimicrobial resistance spread prevention and control (p < .0001). Implications: Formalization and standardization may eliminate staff role conflict, whereas centralized authority may minimize ambiguity. Culture and communication likely promote internal trust, whereas information technology use helps integrate and support these organizational processes. These findings suggest concrete strategies for evaluating current capabilities to implement effective practices and foster and sustain a culture of patient safety.

Original languageEnglish
Pages (from-to)308-322
Number of pages15
JournalHealth Care Management Review
Volume33
Issue number4
DOIs
StatePublished - Oct 2008

Fingerprint

Centers for Disease Control and Prevention (U.S.)
Communicable Diseases
Communication
Anti-Bacterial Agents
Technology
Outcome and Process Assessment (Health Care)
Information Management
Patient Safety
Infection Control
Decision Making
Patient Care
Incidence
Infection
Control strategy
Factors
Antimicrobial resistance
Disease control
Disease prevention
Infectious diseases
Antibiotics

Keywords

  • Contingency theory
  • Implementation
  • Infection control
  • Patient safety
  • Quality

ASJC Scopus subject areas

  • Health Policy
  • Leadership and Management
  • Strategy and Management

Cite this

Structural and process factors affecting the implementation of antimicrobial resistance prevention and control strategies in U.S. hospitals. / Chou, Ann F.; Yano, Elizabeth M.; McCoy, Kimberly D.; Willis, Deanna; Doebbeling, Bradley N.

In: Health Care Management Review, Vol. 33, No. 4, 10.2008, p. 308-322.

Research output: Contribution to journalArticle

Chou, Ann F. ; Yano, Elizabeth M. ; McCoy, Kimberly D. ; Willis, Deanna ; Doebbeling, Bradley N. / Structural and process factors affecting the implementation of antimicrobial resistance prevention and control strategies in U.S. hospitals. In: Health Care Management Review. 2008 ; Vol. 33, No. 4. pp. 308-322.
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