Development of the Korean Standardized Antimicrobial Administration Ratio as a Tool for Benchmarking Antimicrobial Use in Each Hospital

Abstract

Background The Korea National Antimicrobial Use Analysis System (KONAS), a benchmarking system for antimicrobial use in hospitals, provides Korean Standardized Antimicrobial Administration Ratio (K-SAAR) for benchmarking. This article describes K-SAAR predictive models to enhance the understanding of K-SAAR, an important benchmarking strategy for antimicrobial usage in KONAS. Methods We obtained medical insurance claims data for all hospitalized patients aged ≥ 28 days in all secondary and tertiary care hospitals in South Korea (n = 347) from January 2019 to December 2019 from the Health Insurance Review & Assessment Service. Modeling was performed to derive a prediction value for antimicrobial use in each institution, which corresponded to the denominator value for calculating K-SAAR. The prediction values of antimicrobial use were modeled separately for each category, for all inpatients and adult patients (aged ≥ 15 years), using stepwise negative binomial regression. Results The final models for each antimicrobial category were adjusted for different significant risk factors. In the K-SAAR models of all aged patients as well as adult patients, most antimicrobial categories included the number of hospital beds and the number of operations as significant factors, while some antimicrobial categories included mean age for inpatients, hospital type, and the number of patients transferred from other hospitals as significant factors. Conclusion We developed a model to predict antimicrobial use rates in Korean hospitals, and the model was used as the denominator of the K-SAAR.

Days of Antibiotic Spectrum Coverage Trends and Assessment in Patients with Bloodstream Infections: A Japanese University Hospital Pilot Study

“…Ideally, antibiotic use metrics should evaluate antimicrobial use appropriateness or standardization [ 28 , 29 , 30 ]. The standardized antimicrobial administration ratio (SAAR), which was risk-adjusted for hospital-level and unit-level factors, has been implemented as a standardized benchmark of antibiotic use in the United States, although conventional metrics could not be quantitatively evaluated for appropriateness [ 28 ].…”

Current Status and Prospect of Qualitative Assessment of Antibiotics Prescriptions

“…For effective antibiotic stewardship, the Infectious Diseases Society of America and Society for Healthcare Epidemiology of America recommends measuring the amount of antibiotics used to identify trends in antibiotics use at medical institutions [ 10 ]. In Korea, the Korea National Antimicrobial Use Analysis System (KONAS) monitors the antibiotics consumption at various national medical institutions [ 11 12 ]. However, it is difficult to determine the inappropriate antibiotics use that is a target of intervention because it is challenging to accurately identify the point where inappropriate antibiotics use is taking place at medical institutions only by recording the number of antibiotics used.…”

Core Elements for Implementing Antimicrobial Stewardship Programs in Korean General Hospitals

“…In some developed countries, including the United States, a benchmarking system that performs comparisons with external hospitals, measures changes in antimicrobial usage over time inside the hospital, and provides feedback is being operated at the national level to evaluate the level of antimicrobial use at individual medical facilities along with the evaluation of antimicrobial usage at medical facilities nationwide and to efficiently set improvement goals [ 93 ]. In Korea, the Korea National Antimicrobial Use Analysis System (KONAS), a benchmarking system that allows individual facilities to measure the amount of antimicrobials used within their facilities and compare and analyze them with those of other facilities, has been established in 2021, and it is necessary to promote each medical facility to actively utilize the system [ 96 ]. When an individual hospital applies for KONAS participation and agrees to transfer health insurance claim data from HIRA to KONAS, antimicrobial usage by class within the medical facilities is provided by days of therapy and daily defined doses, respectively.…”

“…When an individual hospital applies for KONAS participation and agrees to transfer health insurance claim data from HIRA to KONAS, antimicrobial usage by class within the medical facilities is provided by days of therapy and daily defined doses, respectively. Simultaneously, by providing SAAR, which is an index comparing the expected antimicrobial use with the actual antimicrobial use of the facility, the level of antimicrobial use at the facility can be efficiently determined [ 96 97 ].…”

“…Electronic health records in hospitals best reflect actual antimicrobial usage, but in Korea, no unified computerized system exists among hospitals, and most hospitals do not have a system measuring the antimicrobial usage or workforce to analyze the amount of antimicrobial use, making it difficult to use electronic health records. From a long-term perspective, a system should be established that can analyze and monitor antimicrobial usage based on electronic health records led by the KDCA [ 93 96 ].…”