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

Abstract

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.

Interventions to Improve Antimicrobial Stewardship for Older People in Care Homes: A Systematic Review

“…Duration of treatment, or days of therapy, can be used to measure antimicrobial use regardless of changes in antimicrobial doses [55]. Indeed, days of therapy approach was one of six recommended metrics to assess antimicrobial stewardship interventions in acute-care settings according to an expert consensus [60]. Although duration of antimicrobial treatment may not be measured in some settings due to unavailability of patient-level data [53,61], this outcome should be considered in future research focusing on antimicrobial stewardship in care homes.…”

Antibiotic Stewardship in Small Hospitals: Barriers and Potential Solutions

“…A complete discussion of the types of quality measures available for ASPs is outside the scope of this review, but many excellent reviews are available [26,[38][39][40][41]. Measuring antibiotic consumption is the most common type of measure used by ASPs and is integral to identify opportunities for improvement, evaluate the impact of interventions, and participate in interhospital benchmarking [42].…”

Potential Impact of Antibiotic Stewardship Programs on Overall Antibiotic Use in Adult Acute-Care Hospitals in the United States

“…A few studies showed no change or a decrease in Clostridium difficile infection and antibiotic-resistant pathogens, which are important metrics for assessing the patient-level impact of antibiotic stewardship. 4 …”