Outpatient Antibiotic Stewardship Initiative


Provider and patient education, best practices and clinical decision support tools, and ongoing feedback are driving change in outpatient prescribing practices.

Launched in February 2016, the Outpatient Antibiotic Stewardship Initiative is a United Hospital Fund-led effort involving hospitals across the metropolitan area working together to improve antibiotic-prescribing practices in the community.

In the first year of the initiative, nine New York hospitals and health systems, eight of whom received an aggregate $310,180 in UHF grant support, sought to assess current outpatient antibiotic-prescribing practices for patients with acute respiratory infections (ARIs) and identify factors driving them. The participants—Interfaith Medical Center, MediSys Health Network, Memorial Sloan Kettering Cancer Center, Montefiore Medical Center, Mount Sinai Health System, NewYork-Presbyterian/Queens, Northwell Health, NYU Langone Medical Center, and Wyckoff Heights Medical Center—also aimed to bring additional institutional resources to bear on the challenge of developing and implementing successful approaches to antibiotic stewardship.

Thirty-one hospital outpatient sites—two to five sites per participating hospital or health system—worked to assess the current status of antibiotic stewardship in their outpatient settings, gather information on provider knowledge and attitudes about antibiotics, and analyze prescribing practices for adult patients with ARIs (national data suggest significant over-prescription and misuse of antibiotics for those conditions). UHF created the structure for the initiative, led learning sessions and webinars, and provided technical assistance and access to content experts.

An advisory group of infectious disease physicians, pharmacists, and outpatient clinicians worked with UHF to develop tools for participating practices to use in patient chart reviews and key informant interviews, to assess current antibiotic stewardship practices.

Beginning in May 2017, seven initiative participants moved on to developing, pilot testing, and evaluating systematic interventions and stewardship. Participating in Stage II of the initiative are 36 hospital-owned physician practices from MediSys Health Network, Memorial Sloan Kettering Cancer Center, Montefiore Medical Center, Mount Sinai Health System, NewYork-Presbyterian Queens, NYU Langone Medical Center, and Wyckoff Heights Medical Center, with six of those systems receiving additional aggregate UHF support of $300,000.

Goals of Stage II include driving practice change through formalizing provider education, developing best-practice advisories and other clinical decision support tools, providing feedback to providers on their prescribing practices, and implementing patient education on appropriate use of antibiotics and the dangers of antimicrobial resistance.

The Outpatient Antibiotic Stewardship Initiative complements the Antibiotic Stewardship Certificate Program launched early in 2015 by co-leaders United Hospital Fund and Greater New York Hospital Association to focus primarily on antibiotic stewardship in the inpatient setting. The initiative is also intended to complement the Get Smart: Know When Antibiotics Work program of the Centers for Disease Control and Prevention, as well as the New York State Department of Health’s efforts.

Nationally, over 250 million prescriptions for antibiotics are written each year (in all settings), and studies have shown that up to 50 percent of antibiotic use is inappropriate.

Contact: Joan GuzikPooja Kothari