Quality Indicators to Measure Appropriate Antibiotic Use in Hospitalized Adults

Bosch, Caroline M. A. van den; Geerlings, Suzanne E.; Natsch, Stephanie; Prins, Jan M.; Hulscher, Marlies

doi:10.1093/cid/ciu747

Cited by 142 publications

(122 citation statements)

References 19 publications

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“…All Delphi studies were performed with a multidisciplinary team of experts, working in different hospitals. Two studies, van den Bosch et al 14,29 and Drive AB, 30 performed the consensus procedure with an international team of experts. The panel size varied from 11 to 51 experts.…”

Section: Resultsmentioning

confidence: 99%

“…For two sets of indicators the relation between adherence to the QIs, and length of hospital stay was investigated in a subsequent observational multicenter trial. 14,31 …”

Section: Resultsmentioning

confidence: 99%

“…is the only study so far to have developed a generic set of QIs of which the relation to outcome measures was assessed during a Delphi study and in an additional trial. 14 As was stated before, a requirement for an effective stewardship program is the ability to measure the appropriateness of antibiotic use using QIs. For an optimal use of the developed QIs it is mandatory to test their clinimetric properties in daily practice, in order to discriminate between indicators that are feasible, valid and reliable in a specific setting and those that are not.…”

Section: Discussionmentioning

confidence: 99%

“…It is mandatory to locally test the clinimetric properties of the QIs, in order to discriminate between indicators that are feasible, valid and reliable in a specific setting and those that are not. There are several criteria to consider when assessing the QIs, including measurability, 12-14 applicability (the indicator should be applicable to a substantial proportion of the reviewed patient records), 14,15 inter-observer reliability, 12-14,16-18 room for improvement, 10,12-14 and case mix stability. 12-14,17 …”

Section: Introductionmentioning

confidence: 99%

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A Systematic Review of Quality Indicators for Appropriate Antibiotic Use in Hospitalized Adult Patients

Kallen

Prins

2017

Infectious Disease Reports

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Many quality indicators for appropriate antibiotic use have been developed. We aimed to make a systematic inventory, including the development methodology and validation procedures, of currently available quality indicators (QIs) for appropriate antibiotic use in hospitalized adult patients. We performed a literature search in the Pubmed interface. From the included articles we abstracted i) the indicators developed ii) the type of infection the QIs applied to iii) study design used for the development of the QIs iv) relation of the QIs to outcome measures v) whether the QIs were validated and vi) the characteristics of the validation cohort. Fourteen studies were included, in which 200 QIs were developed. The most frequently mentioned indicators concerned empirical antibiotic therapy according to the guideline (71% of studies), followed by switch from IV to oral therapy (64% of studies), followed by drawing at least two sets of blood cultures and change to pathogen-directed therapy based on culture results (57% of studies). Most QIs were specifically developed for lower respiratory tract infection, urinary tract infection or sepsis. A RAND-modified Delphi procedure was used in the majority of studies (57%). Six studies took outcome measures into consideration during the procedure. Five out of fourteen studies (36%) tested the clinimetric properties of the QIs and 65% of the tested QIs were considered valid. Many studies report the development of quality indicators for appropriate antibiotic use in hospitalized adult patients. However, only a small number of studies validated the developed QIs. Future validation of QIs is needed if we want to implement them in daily practice.

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Section: Resultsmentioning

confidence: 99%

“…For two sets of indicators the relation between adherence to the QIs, and length of hospital stay was investigated in a subsequent observational multicenter trial. 14,31 …”

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

A Systematic Review of Quality Indicators for Appropriate Antibiotic Use in Hospitalized Adult Patients

Kallen

Prins

2017

Infectious Disease Reports

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“…Prior expert consensus processes that focused on selecting metrics for antimicrobial stewardship have not specifically focused on the impact of patient-level interventions and the goal of informing internal program decision making. In contrast, other panels have attempted to select quality indicators to be used for external comparisons or focused on appropriateness of antibiotic use alone [8,9]. Morris et al convened a panel of 10 US and Canadian experts to define quality improvement metrics for ASPs, including 2 measures to be used for public reporting [8].…”

Section: Discussionmentioning

confidence: 99%

Expert Consensus on Metrics to Assess the Impact of Patient-Level Antimicrobial Stewardship Interventions in Acute-Care Settings

Moehring

Anderson

Cochran

et al. 2016

CLINID

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Antimicrobial stewardship programs (ASPs) positively impact patient care, but metrics to assess ASP impact are poorly defined. We used a modified Delphi approach to select relevant metrics for assessing patient-level interventions in acute-care settings for the purposes of internal program decision making. An expert panel rated 90 candidate metrics on a 9-point Likert scale for association with 4 criteria: improved antimicrobial prescribing, improved patient care, utility in targeting stewardship efforts, and feasibility in hospitals with electronic health records. Experts further refined, added, or removed metrics during structured teleconferences and re-rated the retained metrics. Six metrics were rated >6 in all criteria: 2 measures of Clostridium difficile incidence, incidence of drug-resistant pathogens, days of therapy over admissions, days of therapy over patient days, and redundant therapy events. Fourteen metrics rated >6 in all criteria except feasibility were identified as targets for future development.Keywords. antimicrobial stewardship; patient safety; process measure; outcome measure; quality metrics. We aimed to gain expert consensus on a list of metrics both useful for assessing the impact of patient-level antimicrobial stewardship interventions and feasible to measure in acutecare hospitals with an electronic health record. The goals of this study were not to identify quality metrics to be used for external comparisons or value-based incentives, but rather to identify metrics most pertinent for internal ASP decisions. METHODSWe performed a modified Delphi, expert consensus-building process to identify metrics useful for tracking the impact of patient-level antimicrobial stewardship interventions. The method differed from the Delphi process developed by the RAND Corporation because it did not include face-to-face meetings [5]. Rather, Web-based teleconferences and electronic surveys enabled the geographically diverse group of experts to participate without logistical barriers. The steps of the process included a comprehensive literature review to develop a candidate metrics list, 2 rounds of electronic surveys for metric rating, data collection, analyses, and feedback to the panel members, and structured, Web-based teleconference discussions between the electronic survey rounds.

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Engaging hospitalists in antimicrobial stewardship: Lessons from a multihospital collaborative

Mack

Rohde

Jacobsen

et al. 2016

Journal of Hospital Medicine

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Inappropriate antimicrobial use in hospitalized patients contributes to antimicrobial‐resistant infections and complications. We sought to evaluate the impact, barriers, and facilitators of antimicrobial stewardship best practices in a diverse group of hospital medicine programs. This multihospital initiative included 1 community nonteaching hospital, 2 community teaching hospitals, and 2 academic medical centers participating in a collaborative with the Centers for Disease Control and Prevention and the Institute for Healthcare Improvement. We conducted multimodal physician education on best practices for antimicrobial use including: (1) enhanced antimicrobial documentation, (2) improved quality and accessibility of local clinical guidelines, and (3) a 72‐hour antimicrobial “timeout.” Implementation barriers included variability in physician practice styles, lack of awareness of stewardship importance, and overly broad interventions. Facilitators included engaging hospitalists, collecting real time data and providing performance feedback, and appropriately limiting the scope of interventions. In 2 hospitals, complete antimicrobial documentation in sampled medical records improved significantly (4% to 51% and 8% to 65%, P < 0.001 for each comparison). A total of 726 antimicrobial timeouts occurred at 4 hospitals, and 30% resulted in optimization or discontinuation of antimicrobials. With careful attention to key barriers and facilitators, hospitalists can successfully implement effective antimicrobial stewardship practices. Journal of Hospital Medicine 2016;11:576–580. © 2016 Society of Hospital Medicine

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Quality Indicators to Measure Appropriate Antibiotic Use in Hospitalized Adults

Abstract: The selected QIs can be used in antibiotic stewardship programs to determine for which aspects of antibiotic use there is room for improvement. At this moment we are testing the clinimetric properties of these QIs in 1800 hospitalized patients, in 22 Dutch hospitals.

Cited by 142 publications

References 19 publications

A Systematic Review of Quality Indicators for Appropriate Antibiotic Use in Hospitalized Adult Patients

A Systematic Review of Quality Indicators for Appropriate Antibiotic Use in Hospitalized Adult Patients

Expert Consensus on Metrics to Assess the Impact of Patient-Level Antimicrobial Stewardship Interventions in Acute-Care Settings

Engaging hospitalists in antimicrobial stewardship: Lessons from a multihospital collaborative

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