Peer Comparison of Anti-MRSA Agent Prescription in the Inpatient Setting

Bork, Jacqueline T.; Morgan, Daniel J.; Heil, Emily L.; Pineles, Lisa; Kleinberg, Michael

doi:10.1017/ice.2017.219

Cited by 4 publications

(3 citation statements)

References 5 publications

(7 reference statements)

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“…Outpatient practices and some hospital ASPs use individual prescriber data feedback with peer comparisons of antibiotic use to encourage behavior change. 31,32 The addition of postdischarge data to inpatient prescriber feedback reports would provide a more comprehensive look at antibiotic use by prescriber, especially in assessments of antibiotic duration attributed to the inpatient stay and specific syndromes. ASPs that do not attempt to measure postdischarge days may underestimate the effects of inpatient stewardship initiatives on antibiotic use, especially for interventions that intend to shorten durations of therapy.…”

Section: Discussionmentioning

confidence: 99%

Total duration of antimicrobial therapy resulting from inpatient hospitalization

Dyer

Ashley

Anderson

et al. 2019

Infect. Control Hosp. Epidemiol.

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Objective:To assess the feasibility of electronic data capture of postdischarge durations and evaluate total durations of antimicrobial exposure related to inpatient hospital stays.Design:Multicenter, retrospective cohort study.Setting:Two community hospitals and 1 academic medical center.Patients:Hospitalized patients who received ≥1 dose of a systemic antimicrobial agent.Methods:We collected and reviewed electronic data on inpatient and discharge antimicrobial prescribing from April to September 2016 in 3 pilot hospitals. Inpatient antimicrobial use was obtained from electronic medication administration records. Postdischarge antimicrobial use was calculated from electronic discharge prescriptions. We completed a manual validation to evaluate the ability of electronic prescriptions to capture intended postdischarge antibiotics. Inpatient, postdischarge, and total lengths of therapy (LOT) per admission were calculated to assess durations of antimicrobial therapy attributed to hospitalization.Results:A total of 45,693 inpatient admissions were evaluated. Antimicrobials were given during 23,447 admissions (51%), and electronic discharge prescriptions were captured in 7,442 admissions (16%). Manual validation revealed incomplete data capture in scenarios in which prescribers avoided the electronic system. The postdischarge LOT among admissions with discharge antimicrobials was median 8 days (range, 1–360) with peaks at 5, 7, 10, and 14 days. Postdischarge days accounted for 38% of antimicrobial exposure days.Conclusion:Discharge antimicrobial therapy accounted for a large portion of antimicrobial exposure related to inpatient hospital stays. Discharge prescription data can feasibly be captured through electronic prescribing records and may aid in designing stewardship interventions at transitions of care.

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Section: Discussionmentioning

confidence: 99%

Total duration of antimicrobial therapy resulting from inpatient hospitalization

Dyer

Ashley

Anderson

et al. 2019

Infect. Control Hosp. Epidemiol.

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“…Sociobehavioral research on the way human medicine clinicians respond to AMU data targeted at them individually demonstrates that considerable skepticism and lack of trust can surround feedback reports, contributing to gaming and workarounds (17). Before implementing an ASP intervention, clinician confidence in the measurement system must be secured to boost clinicians' acceptance of feedback data and increase motivation to change (18,19). The goal of this study was therefore to identify the perceptions that veterinary clinicians working in the US hospital setting hold toward different AMU metrics used for the systematic tracking and reporting of AMU for purposes of stewardship.…”

Section: Introductionmentioning

confidence: 99%

Small and Large Animal Veterinarian Perceptions of Antimicrobial Use Metrics for Hospital-Based Stewardship in the United States

2020

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Background: Robust measurement and tracking of antimicrobial use (AMU) is a fundamental component of stewardship interventions. Feeding back AMU metrics to individual clinicians is a common approach to changing prescribing behavior. Metrics must be meaningful and comprehensible to clinicians. Little is known about how veterinary clinicians working in the United States (US) hospital setting think about AMU metrics for antimicrobial stewardship. Objective: To identify hospital-based veterinary clinicians' attitudes toward audit and feedback of AMU metrics, their perceptions of different AMU metrics, and their response to receiving an individualized prescribing report. Methods: Semi-structured interviews were conducted with veterinarians working at two hospitals in the Eastern US. Interviews elicited perceptions of antimicrobial stewardship in veterinary medicine. Respondents were shown a personalized AMU Report characterizing their prescribing patterns relative to their peers and were asked to respond. Interviews were recorded, transcribed, and analyzed using the framework method with matrices. Results: Semi-structured interviews were conducted with 34 veterinary clinicians (22 small animal and 12 large animal). Respondents generally felt positive about the reports and were interested in seeing how their prescribing compared to that of their peers. Many respondents expressed doubt that the reports accurately captured the complexities of their prescribing decisions and found metrics associated with animal daily doses (ADDs) confusing. Only 13 (38.2%) respondents felt the reports would change how they used antimicrobials. When asked how the impact of the reports could be optimized, respondents recommended providing a more detailed explanation of how the AMU metrics were derived, education prior to report roll-out, guidance on how to interpret the metrics, and development of meaningful benchmarks for goal-setting. Conclusions: These findings provide important insight that can be used to design veterinary-specific AMU metrics as part of a stewardship intervention that are meaningful to clinicians and more likely to promote judicious prescribing.

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“…[9][10][11][12] Additionally, there has been recent interest in the use of peer comparison as a tool for modification of individual prescription practices. 13 Mayo Clinic in Rochester, Minnesota, has had restriction policies in place to limit the use of the carbapenem class of antibiotics. Primary treatment teams at Mayo Clinic can use these restricted antibiotics with approval from the ASP if they meet predetermined criteria, or if approved by an ID faculty physician, who rotate on the ASP service on a weekly basis.…”

Section: Introductionmentioning

confidence: 99%

Infectious disease physician characteristics and prescription of meropenem in the hospital

Challener

O’Horo

Tande

2023

ASHE

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Objective: Physician characteristics may be correlated with medical treatment decisions and patient outcomes. This study examined the correlations between characteristics of infectious disease (ID) physicians and the use of the restricted antimicrobial meropenem. Design: This was a retrospective cohort study following 27 attending ID physicians for 5 years at a large academic medical center. Methods: All inpatient ID clinical encounters between 2013 and 2018 were assessed for physician and patient characteristics, including patient Charlson Comorbidity Index, patient sex, ID service seeing the patient, physician career stage, physician training location, and physician sex. Adjusted and unadjusted odds ratios were calculated for the receipt of meropenem on the same day as an ID clinical note. Results: Between 2013 and 2018, meropenem was administered on the same day as 9046 (11.1%) of 81,787 inpatient ID encounters. After adjustment for patient and practice-specific factors, physician career stage was associated with administration of meropenem. Patients seen by mid-career and late-career ID physicians were more likely to receive meropenem than those seen by early-career physicians (aOR 1.22 95% confidence interval [CI 1.13–1.31 and aOR 1.17 95% CI 1.10–1.25, respectively). Conclusions: ID provider characteristics may help target future antimicrobial stewardship program interventions.

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Peer Comparison of Anti-MRSA Agent Prescription in the Inpatient Setting

Cited by 4 publications

References 5 publications

Total duration of antimicrobial therapy resulting from inpatient hospitalization

Total duration of antimicrobial therapy resulting from inpatient hospitalization

Small and Large Animal Veterinarian Perceptions of Antimicrobial Use Metrics for Hospital-Based Stewardship in the United States

Infectious disease physician characteristics and prescription of meropenem in the hospital

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