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Survey of Hospital Antibiotic Stewardship Practices Reveals Room for Improvement

06/14/17

Dateline:

IRVING, Texas
"Follow-up work to this project can identify the facilitators that enabled full compliance in 34 percent of the hospitals."

IRVING, Texas--(BUSINESS WIRE)--According to a study conducted by researchers at Vizient, Inc. and Virginia Commonwealth University (VCU) Health, many small-and medium-sized U.S. hospitals are challenged to meet national guidelines for antibiotic stewardship programs (ASPs). The study shows that the gaps are due, in particular, to a lack of necessary support and resources to address the overuse of antibiotics.

Antibiotic stewardship—coordinated, multi-faceted efforts to ensure the appropriate use of antibiotics—is an issue of growing urgency for the nation’s hospitals and public health at large. Two million people in the U.S. are infected with antibiotic-resistant bacteria annually, and 23,000 die each year as a direct result of drug-resistant infections. In addition, 30 percent of antibiotics prescribed are unnecessary, despite the fact that excessive use of antibiotics contributes significantly to drug resistance.

In response to this growing public health crisis, in 2016, the Centers for Medicare and Medicaid Services (CMS) proposed a rule that would require hospitals to implement ASPs in order to be eligible for Medicare and Medicaid reimbursement. The proposed rule recommends that a hospital ASP follow national guidelines, which may include (final rule pending) the Centers for Disease Control and Prevention’s (CDC’s) Core Elements of Hospital Antibiotic Stewardship Programs. Hospital accreditation and quality organizations, such as the Joint Commission, have also followed and are requiring hospitals to have a stewardship program in place.

Through a survey of U.S. hospitals, Vizient and VCU Health sought to gauge the state of current hospital ASPs, assess their readiness with proposed regulatory requirements, and identify tools and resources to aid with hospital program improvement.

Key Study Findings

  • Only 34 percent of the 211 hospitals surveyed by Vizient were in compliance with all of the CDC’s Core Elements for ASPs. In addition, 17 percent of hospitals reported having no formal antibiotic program in place.
  • High-performing hospital ASPs had a number of defining characteristics:
    • 82 percent were led by organizations connected to a health system
    • 89 percent provided formal infectious disease training to staff
    • 76 percent compensated physicians for participating
  • Academic medical centers (AMCs) were more likely to have a high-performing ASP, compared to community hospitals. Medium and small community hospitals had the least comprehensive programs, accounting for more than half (58 percent) of all low-performing ASPs.
  • Nearly half (45 percent) of hospitals said they did not have a formal written statement of leadership support for antibiotic stewardship, which is considered a crucial CDC Core Element.
  • Just one-quarter (25 percent) conducted routine antibiotic “timeouts,” where drugs are systematically assessed for appropriateness. And, only 6 percent of programs required documentation of the indication, dose, and duration for all antibiotics in the patient medical record or during order entry.

The findings indicate that, across the board, there are improvement opportunities for hospitals in controlling the use of antibiotics, most notably by securing leadership involvement and support for these programs. Other opportunity areas include: compensating physicians for antibiotic stewardship, providing formal infectious disease training to medical staff, adopting antibiotic timeouts, and improving documentation of antibiotic use in the medical record.

There are also significant differences in the composition of ASPs by hospital type. Small- and medium-sized community hospitals were the least likely to have implemented a high-performing ASP. The most comprehensive, high-performing programs were led by AMCs and hospitals connected to larger health systems.

“Smaller community hospitals, which often lack the infrastructure and resources afforded to larger, connected hospitals, have some significant gaps to overcome before future antibiotic stewardship mandates take effect,” said Kristi Kuper, Pharm.D., BCPS, senior clinical manager, infectious diseases at Vizient. “The research suggests that outside support and investment may be needed to help this group of hospitals, in particular, with implementing ASPs and strengthening current programs. Identifying partnership opportunities with larger health systems will also likely be an important strategy.”

“There is still much to learn regarding effective strategies to enhance antimicrobial stewardship services in hospitals,” said Amy Pakyz, Pharm.D., Ph.D., associate professor at VCU School of Pharmacy. “Follow-up work to this project can identify the facilitators that enabled full compliance in 34 percent of the hospitals.”

Methodology

The survey was sent in April and May 2016 to 446 Vizient member organizations through the company’s antimicrobial stewardship electronic list-serve. Of the organizations contacted, 211 (47 percent) responded. The types of hospitals represented in the 211 respondents included:

  • Academic Medical Centers (34 percent)
  • Medium-sized Community Hospitals (23 percent)
  • Large Community Hospitals (19 percent)
  • Small Community Hospitals (13 percent)
  • Critical Access Hospitals (10 percent)
  • Other Hospitals (1 percent)

Members of the Vizient Antimicrobial Stewardship Network Taskforce developed questions based on the CDC Core Elements and the antibiotic stewardship measures on the CMS Infection Control Worksheet. From the responses, a stewardship score for each organization was calculated based on CDC Core Elements for a total possible score of 20. Hospitals with high-performing ASPs were categorized as receiving a stewardship score of 13 to 20. Those with low-performing ASPs received a stewardship score of one to eight.

About Vizient, Inc.

Vizient, Inc., the largest member-driven health care performance improvement company in the country, provides innovative data-driven solutions, expertise and collaborative opportunities that lead to improved patient outcomes and lower costs. Vizient’s diverse membership base includes academic medical centers, pediatric facilities, community hospitals, integrated health delivery networks and non-acute health care providers and represents more than $100 billion in annual purchasing volume. The Vizient brand identity represents the integration of VHA Inc., University HealthSystem Consortium and Novation, which combined in 2015, as well as MedAssets’ Spend and Clinical Resource Management (SCM) segment, including Sg2, which was acquired in 2016. In 2017, Vizient again received a World’s Most Ethical Company designation from the Ethisphere Institute. Vizient’s headquarters are in Irving, Texas, with locations in Chicago and other cities across the United States. Please visit www.vizientinc.com as well as our newsroomblogTwitterLinkedIn and YouTube pages for more information about the company.

About VCU and VCU Health

Virginia Commonwealth University is a major, urban public research university with national and international rankings in sponsored research. Located in downtown Richmond, VCU enrolls more than 31,000 students in 225 degree and certificate programs in the arts, sciences and humanities. The VCU Health brand represents the health sciences schools of VCU, the VCU Massey Cancer Center and the VCU Health System, which comprises VCU Medical Center (the only academic medical center and Level I trauma center in the region), Community Memorial Hospital, Children’s Hospital of Richmond at VCU, MCV Physicians and Virginia Premier Health Plan. For more, please visit  www.vcu.edu  and  vcuhealth.org .

Contact:

Vizient, Inc.
Angie Boliver, 972-830-7961
angie.boliver@vizientinc.com

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