UHF's Outpatient Antibiotic Stewardship Initiative: A Look-Back

By Joan Guzik, MBA, and Pooja Kothari, RN, MPH

Joan Guzik is the director of quality improvement for UHF’s Quality Institute. Pooja Kothari, RN, MPH, is a senior program manager in UHF’s Quality Institute and UHF’s 2019 Patricia S. Levinson fellow.

According to a U.S. Centers for Disease Control and Prevention report released last week, antibiotic-resistant bacteria and fungi cause more than 2.8 million infections and 35,000 deaths in the U.S. each year. The CDC found that, nationwide, there were nearly twice as many annual deaths from antibiotic-resistant infections as the agency had originally reported in a 2013 publication.

This week is U.S. Antibiotic Awareness Week—a perfect time to review a major United Hospital Fund program designed to combat antibiotic resistance. In 2018, UHF completed the second stage of a grant initiative to promote the development of outpatient antibiotic stewardship programs in over 30 hospital-owned clinics from 7 hospitals and health systems. The focus of the initiative was simple but challenging: improve appropriate antibiotic prescribing for acute respiratory infections in adult patients. 


Petri dish with Staphylococcus aureus culture

Findings from UHF’s Outpatient Antibiotic Stewardship Initiative indicated a moderate decrease in antibiotic prescribing among participating providers based on pre- and post- intervention data. As the grant initiative came to an end, there was a focus on sustaining improvements in antibiotic prescribing and continuing the evidence-based interventions at the clinics.

In 2019, UHF followed up with the teams via a survey to learn how they were faring on sustaining and spreading their antibiotic stewardship interventions. We then reconvened by phone all of the team leads as well as two faculty members: Belinda Ostrowsky, MD, MPH, a New York field medical officer for the CDC; and Gopi Patel, MD, MS, an associate professor and director of antibiotic stewardship at Mount Sinai Hospital. The call led to a discussion about challenges the teams were facing and updates on ongoing stewardship interventions.

Most of the outpatient clinics continued several activities, including:
•    Monitoring antibiotic prescribing rates 
•    Developing and distributing individual provider report cards on antibiotic prescribing on a regular basis
•    Offering provider education on antibiotic stewardship
•    Educating patients about antibiotic use and resistance
•    Presenting data on antibiotic prescribing to quality improvement committees, infection control committees, and clinic and hospital leadership 

Some teams were still fine-tuning their interventions based on lessons learned during the initiative, and some are also still expanding their outpatient antibiotic stewardship programs to serve other clinics and populations (e.g., pediatrics) and to address other infections (e.g., urinary tract infections). One of the teams had also been especially engaged in community outreach and is currently providing monthly programming in the community (e.g., churches, senior centers, libraries) to educate the public on appropriate antibiotic use. 

Despite some challenges related to staffing, time, and competing priorities, it was extremely encouraging to see that the hospitals and health systems continue to track their antibiotic prescribing rates and have managed to sustain several of their interventions.

As part of the initiative, UHF developed the Antibiotic Stewardship for Acute Respiratory Infections—The Milstein Toolkit for Ambulatory Care Practices, which distills the lessons learned from the initiative and provides access to the data collection tools and surveys used during the initiative. In addition, findings from the initiative’s first stage and second stage were published in the journal Infection Control and Hospital Epidemiology

Participants in Stage II of the initiative were MediSys Health Network, Memorial Sloan Kettering Cancer Center, Montefiore Medical Center, Mount Sinai Health System, NewYork-Presbyterian Queens, NYU Langone Health, and Wyckoff Heights Medical Center.

We applaud their efforts and their continued vigilance in combating this urgent public health threat.