Nationally, studies have shown that up to 50 percent of antibiotic use is inappropriate. Improved stewardship efforts are critical to ensuring that the right drug, if any, is used at the right time and in the right way.
Antibiotic resistance and the need to control multidrug-resistant organisms, particularly in health care settings, are among the major issues confronting health care providers today. With studies showing that up to 50 percent of antibiotic use is inappropriate, antibiotic stewardship was made a federal priority as well; the Obama administration announced a National Action Plan on the issue in March 2015.
Building on the success of its earlier patient safety and quality improvement work, United Hospital Fund has created, both independently and in partnership with the Greater New York Hospital Association, major initiatives aimed at combating the rise of antibiotic-resistant organisms in health care systems in the greater New York area. Several resources from this effort are noted below, with descriptions and links:
- An overview of the Outpatient Antibiotic Stewardship Initiative
- The Milstein Toolkit for Ambulatory Care Practices
- Two peer-reviewed articles published in the journal Infection Control & Hospital Epidemiology
- Videos with participants in the OASI
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 UHF-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 for patients with acute respiratory infections (ARIs) and identify factors driving them. The participants in Stage I of the initiative wereInterfaith 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.
Thirty-one hospital outpatient sites 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 conducting patient chart reviews and assessment of current antibiotic stewardship practices.
Stage II: Developing Interventions
Beginning in May 2017, seven initiative participants moved on to Stage II of the intiative, developing, pilot testing, and evaluating systematic interventions and stewardship. Participating in Stage II of the initiative were36 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 included 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 Programs launched early in 2015 by UHF and Greater New York Hospital Association. These programs focused on training staff to develop antibiotic stewardship programs in the inpatient and nursing home settings.
Scroll down to see published findings from this initiative, or click here to watch interviews with participants in the project.