Use of a Structured Panel Process to Define Quality Metrics for Antimicrobial Stewardship Programs

Morris, Andrew M.; Brener, S; Dresser, Linda; Daneman, Nick; Dellit, Timothy H.; Avdic, Edina; Bell, Chaim M.

doi:10.1086/665324

Cited by 90 publications

(71 citation statements)

References 36 publications

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“…Prior expert consensus processes that focused on selecting metrics for antimicrobial stewardship have not specifically focused on the impact of patient-level interventions and the goal of informing internal program decision making. In contrast, other panels have attempted to select quality indicators to be used for external comparisons or focused on appropriateness of antibiotic use alone [8,9]. Morris et al convened a panel of 10 US and Canadian experts to define quality improvement metrics for ASPs, including 2 measures to be used for public reporting [8].…”

Section: Discussionmentioning

confidence: 99%

“…In contrast, other panels have attempted to select quality indicators to be used for external comparisons or focused on appropriateness of antibiotic use alone [8,9]. Morris et al convened a panel of 10 US and Canadian experts to define quality improvement metrics for ASPs, including 2 measures to be used for public reporting [8]. The conclusions of this panel had some similarities to the STEWARDS panel: Both selected incidence of drug-resistant infection, including C. difficile infections, and antimicrobial utilization, specifically, days of therapy.…”

Section: Discussionmentioning

confidence: 99%

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

Moehring

Anderson

Cochran

et al. 2016

CLINID

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

Moehring

Anderson

Cochran

et al. 2016

CLINID

View full text Add to dashboard Cite

show abstract

“…Renal wards and pediatric patients were excluded because these populations are known to have large discrepancies between DDD and DOT units. 6,8,9 …”

Section: Inclusion and Exclusion Criteriamentioning

confidence: 99%

“…Since DDD is a method to estimate DOT, DOT have been regarded as the preferable unit. 8 Comparisons of pharmacy-derived DDD to eMAR DOT are potentially useful for comparison of antimicrobial utilization data based on these different units, and discrepancy may arise from either the difference in the units used, or differences in quantity recorded by the 2 data sources. Calculation of DDD from the eMAR data allows the quantification of these 2 sources of discrepancy.…”

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confidence: 99%

Assessment of Antimicrobial Utilization Metrics: Days of Therapy Versus Defined Daily Doses and Pharmacy Dispensing Records Versus Nursing Administration Data

Dalton

Sabuda

Bresee

et al. 2015

Infect. Control Hosp. Epidemiol.

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“…This report supports the application of the quality metrics denned by To the Editor-Globally, about 35 million healthcare workers (HCWs)-including doctors, nurses, laboratory staff, and housekeeping attenders-are at risk of sharps injury every year. 1 A sharps injury is a penetrating stab wound from a…”

mentioning

confidence: 99%

Measuring Quality Metrics to Identify and Monitor Antimicrobial Stewardship Program Quality Improvement Efforts

Guervil

Klinker

Reardon

et al. 2014

Infect. Control Hosp. Epidemiol.

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Use of a Structured Panel Process to Define Quality Metrics for Antimicrobial Stewardship Programs

Cited by 90 publications

References 36 publications

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

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

Assessment of Antimicrobial Utilization Metrics: Days of Therapy Versus Defined Daily Doses and Pharmacy Dispensing Records Versus Nursing Administration Data

Measuring Quality Metrics to Identify and Monitor Antimicrobial Stewardship Program Quality Improvement Efforts

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