Outpatient Antibiotic Stewardship Initiative

 
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Nationally, studies have shown that up to 50 percent of antibiotic use is inappropriate.

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.

STAGE I: ASSESSING THE CHALLENGE
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 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 analyze prescribing practices for adult patients with acute respiratory infections (national data suggest significant over-prescription and misuse of antibiotics for those conditions; New York data show significant variation across the state). 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.

STAGE II: DEVELOPING INTERVENTIONS
Beginning in April 2017, seven initiative participants moved on to developing, pilot testing, and evaluating systematic interventions and stewardship . Participating in Stage II of the initiative are 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 additional aggregate UHF support, for six of those systems, of $300,000.

Goals of Stage II include driving practice change through formalizing provider education, developing best-practice advisories and other tools, providing monthly feedback, and implementing patient education. Thirty-five outpatient practice sites are involved in this phase of the initiative.

The Outpatient Antibiotic Stewardship Initiative complements the Antibiotic Stewardship 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. In March 2015, the Obama administration announced its national action plan on the issue, demonstrating that antibiotic stewardship has become a top federal priority.

Contact: Joan Guzik