A Review of Quality Measures for Assessing the Impact of Antimicrobial Stewardship Programs in Hospitals

Abstract

The growing problem of antimicrobial resistance (AMR) has led to calls for antimicrobial stewardship programs (ASP) to control antibiotic use in healthcare settings. Key strategies include prospective audit with feedback and intervention, and formulary restriction and preauthorization. Education, guidelines, clinical pathways, de-escalation, and intravenous to oral conversion are also part of some programs. Impact and quality of ASP can be assessed using process or outcome measures. Outcome measures are categorized as microbiological, patient or financial outcomes. The objective of this review was to provide an overview of quality measures for assessing ASP and the reported impact of ASP in peer-reviewed studies, focusing particularly on patient outcomes. A literature search of papers published in English between 1990 and June 2015 was conducted in five databases using a combination of search terms. Primary studies of any design were included. A total of 63 studies were included in this review. Four studies defined quality metrics for evaluating ASP. Twenty-one studies assessed the impact of ASP on antimicrobial utilization and cost, 25 studies evaluated impact on resistance patterns and/or rate of Clostridium difficile infection (CDI). Thirteen studies assessed impact on patient outcomes including mortality, length of stay (LOS) and readmission rates. Six of these 13 studies reported non-significant difference in mortality between pre- and post-ASP intervention, and five reported reductions in mortality rate. On LOS, six studies reported shorter LOS post intervention; a significant reduction was reported in one of these studies. Of note, this latter study reported significantly (p < 0.001) higher unplanned readmissions related to infections post-ASP. Patient outcomes need to be a key component of ASP evaluation. The choice of metrics is influenced by data and resource availability. Controlling for confounders must be considered in the design of evaluation studies to adequately capture the impact of ASP and it is important for unintended consequences to be considered. This review provides a starting point toward compiling standard outcome metrics for assessing ASP.

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].…”

The outcome of implementing antimicrobial stewardship program for hospitalized children

“…Most of previous studies had included mortality, length of stay (LOS) and readmission rates as parameters of patient's outcome. 15 Meanwhile, the novel parameter in the present study was early evaluation of clinical conditions whether improved or not after 72 hours of the start of medications.…”

Effectiveness of Antibiotic Use Management in Tianjin (2011–2013): A Quasi-Experimental Study

“…Although antibiotic resistance is a phenomenon that occurs during the natural developmental process, irrational antibiotic use can accelerate the emergence of antibiotic resistance. Education and clinical management in antibiotics use have become strong measures to control bacterial resistance globally through controlling and monitoring the prescription and pre-authorization of antibiotics use [14][15][16]. Causal analysis of irrational antibiotic use was performed by the Chinese government, and significant improvement has been made through specific rectification of antibiotic use.…”