Dataset Information

Impact of a Prospective Audit and Feedback Antimicrobial Stewardship Program at a Veterans Affairs Medical Center: A Six-Point Assessment.

ABSTRACT:

Background

Prospective audit and feedback is a core antimicrobial stewardship program (ASP) strategy; however its impact is difficult to measure.

Methods

Our quasi-experimental study measured the effect of an ASP on clinical outcomes, antimicrobial use, resistance, costs, patient safety (adverse drug events [ADE] and Clostridium difficile infection [CDI]), and process metrics pre- (9/10-10/11) and post-ASP (9/12-10/13) using propensity adjusted and matched Cox proportional-hazards regression models and interrupted time series (ITS) methods.

Results

Among our 2,696 patients, median length of stay was 1 day shorter post-ASP (5, interquartile range [IQR] 3-8 vs. 4, IQR 2-7 days, p<0.001). Mortality was similar in both periods. Mean broad-spectrum (-11.3%), fluoroquinolone (-27.0%), and anti-pseudomonal (-15.6%) use decreased significantly (p<0.05). ITS analyses demonstrated a significant increase in monthly carbapenem use post-ASP (trend: +1.5 days of therapy/1,000 patient days [1000PD] per month; 95% CI 0.1-3.0). Total antimicrobial costs decreased 14%. Resistance rates did not change in the one-year post-ASP period. Mean CDI rates/10,000PD were low pre- and post-ASP (14.2 ± 10.4 vs. 13.8 ± 10.0, p = 0.94). Fewer patients experienced ADEs post-ASP (6.0% vs. 4.4%, p = 0.06).

Conclusions

Prospective audit and feedback has the potential to improve antimicrobial use and outcomes, and contain bacterial resistance. Our program demonstrated a trend towards decreased length of stay, broad-spectrum antimicrobial use, antimicrobial costs, and adverse events.

SUBMITTER: Morrill HJ

PROVIDER: S-EPMC4792438 | biostudies-literature | 2016

REPOSITORIES: biostudies-literature

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Publications

Impact of a Prospective Audit and Feedback Antimicrobial Stewardship Program at a Veterans Affairs Medical Center: A Six-Point Assessment.

Morrill Haley J HJ Caffrey Aisling R AR Gaitanis Melissa M MM LaPlante Kerry L KL

PloS one 20160315 3

<h4>Background</h4>Prospective audit and feedback is a core antimicrobial stewardship program (ASP) strategy; however its impact is difficult to measure.<h4>Methods</h4>Our quasi-experimental study measured the effect of an ASP on clinical outcomes, antimicrobial use, resistance, costs, patient safety (adverse drug events [ADE] and Clostridium difficile infection [CDI]), and process metrics pre- (9/10-10/11) and post-ASP (9/12-10/13) using propensity adjusted and matched Cox proportional-hazards ...[more]

PMID: 26978263

Similar Datasets

Project description:BACKGROUND:Prior authorization, audit and feedback, and pay for performance are the three core "active" strategies of antimicrobial stewardship program (ASP), yet little is known about the individual or combined benefits of such programs, particularly in a pediatric setting. OBJECTIVES:The aim of this study was to compare these core ASP strategies and determine the incremental effect of financially punished audit and feedback. METHODS:During the journey to the Joint Commission International accreditation, a tertiary pediatric medical center performed two different hospital-wide stewardship interventions in succession. The first stage without formalized ASPs served as pre-intervention period, January 2011 to April 2011. The ASP used prior authorization alone during the first-intervention period, May 2011 to September 2011. In October 2011, financially punished audit and feedback was introduced, marking the start of the second-intervention period, October 2011 to November 2012. We compared the differences of the change in monthly average use of antibiotics and expenditure on antibiotics before and after the ASP changes by using interrupted time series via dynamic regression. The main end points included the proportions of antibiotic prescriptions and expenditure on antibacterial relative to all medications. RESULTS:Before the second-intervention period, neither the proportion of antibiotic prescriptions nor the proportion of expenditure on antibiotics declined significantly in both ambulatory and inpatient settings. However, after the introduction of financially punished audit and feedback, the proportion of both antibiotic prescriptions (??=?-6.269, P?<?0.001, and reduction?=?59.4% for outpatients; ??=?-1.235, P?<?0.001, and reduction?=?19.8% for inpatients) and expenditure on antibiotics (??=?-7.777, P?<?0.001, and reduction?=?46.7% for outpatients; ??=?-4.933, P?=?0.001, and reduction?=?16.3% for inpatients) dropped immediately. CONCLUSION:The combination of more than one core strategies (prior authorization, audit and feedback, and pay for performance) will be more effective than one strategy alone.

Dataset Information

Impact of a Prospective Audit and Feedback Antimicrobial Stewardship Program at a Veterans Affairs Medical Center: A Six-Point Assessment.

Background

Methods

Results

Conclusions

Publications

Impact of a Prospective Audit and Feedback Antimicrobial Stewardship Program at a Veterans Affairs Medical Center: A Six-Point Assessment.

Similar Datasets

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