Methods
The regional VISN 9 ASP collaborative was formed in January 2020 to address common issues across facilities and optimize human capital and resources. The initial collaborative included ASP pharmacists but quickly expanded to include physicians and nurse practitioners. The collaborative is co-led by 2 members from different facilities that rotate.
In April 2021, clinical guidance and research/quality improvement (QI) subcommittees were created. The monthly research/QI subcommittee discusses current initiatives and barriers to ongoing research, adapt and disseminate successful interventions to other facilities, and develop new collaborative initiatives. The clinical guidance subcommittee creates and disseminates clinical expert recommendations regarding common issues or emerging needs.
Data Plan and Collection
To measure success and growth, we evaluated annual facility reports that convey the state of each facility’s ASP, outline its current initiatives and progress, highlight areas of need, and set a programmatic goal and strategy for the upcoming year. These reports, required by a VA directive, are submitted annually by each facility to local and VISN leadership and must address the following 7 areas: (1) ASP structure and fulfillment of national VA policy for ASP; (2) fulfillment of the Joint Commission ASP standards; (3) ASP metrics; (4) ASP activities and interventions; (5) ASP QI and research initiatives; (6) education; and (7) goals and priorities.
To standardize evaluation and accurately reflect ASP effort across heterogeneous reports, 4 core areas were identified from areas 1, 3, 4 and 5 listed previously. Area 2 was excluded for its similarity among all facilities, and areas 6 and 7 were excluded for significant differences in definitions and reporting across facilities.
The project team consisted of 5 members from the collaborative who initially discussed definitions and annual report review methodology. A subgroup was assigned to area 1 and another to areas 3, 4, and 5 for initial review and data extraction. Results were later reviewed to address discrepancies and finalize collation and presentation. The impact of the collaborative on individual facilities was measured by both quantitative and qualitative measures. Quantitative measures included: (1) designated ASP pharmacy, physician, or advanced practice provider (APP) full-time equivalents (FTE) at each facility compared with the recommended FTE for facility size; (2) the number of inpatient and outpatient ASP AU metrics for each facility and the VISN total; (3) reported improvement in annual ASP metrics calculated as frequency of improved metrics for each facility and the VISN; (4) the number of QI or research initiatives for each facility and the VISN, which included clinical pathways and order sets; and (5) the number of initiatives published as either abstract or manuscript.10 Additionally, the number of collaborative efforts involving more than 1 facility was tracked. Qualitative data included categories of metrics and QI and research initiatives. Data were collected by year and facility. Facilities are labeled A to E throughout this article.
Along with facility annual ASP reports, facility and VISN AU trends for fiscal years (FY) 2019-2022 were collected from existing VA dashboards tracking AU in both acute respiratory infections (ARI) and in patients with COVID-19. Quantitative data included facility and VISN quarterly AU rates for ARI, extracted from the national VA dashboard. Facility and VISN AU rates in patients with COVID-19 were extracted from a dashboard developed by the VISN 9 ASP collaborative. The VISN 9 Institutional Review Board deemed this work QI and approval was waived.