Study of antimicrobial stewardship programs sheds light on how health systems can reduce antibiotic overuse

Intermountain Healthcare researchers conducted a first-of-its-kind survey to identify and stratify antimicrobial stewardship programs into four different groups – a first step toward studying the effectiveness of these models to best improve patient care. patients and reduce the rise of antibiotic-resistant superbugs.

Antimicrobial stewardship programs are an essential way for hospitals and healthcare systems to ensure that antibiotics are used appropriately. If they continue to be given to patients who do not need them, they can harm those patients while contributing to antibiotic resistance, making bacterial infections harder to treat.

These programs can be as varied as the health systems themselves, leaving researchers in the dark about best practices in their antibiotic approach. That’s why this new work from the team at Intermountain Healthcare is so vital.

“We brought together antimicrobial stewardship leaders from across the country to better understand both the structures and functions of their programs,” said researcher Whitney Buckel, PharmD, pharmacist in charge of antimicrobial stewardship at Intermountain Healthcare. . “We wanted to categorize different approaches to this work, in hopes of then identifying the most effective methods and those that can be used as models for other health systems.”

“You could find 50 different marathon training programs that would all get you to the finish line, but not all of them might be effective or applicable to you. antimicrobials,” added researcher Eddie Stenehjem, MD, medical director. responsible stewardship of antibiotics at Intermountain Healthcare. “We wanted to get a better idea of ​​what’s going on in healthcare settings, primarily for inpatients, so we can start to figure out which programs are best suited for which type of healthcare systems.”

The study, led by Intermountain researchers in collaboration with scientists from Pew Charitable Trusts and the University of Utah, investigated 20 different health systems, including Kaiser Permanente, Mayo Clinic and Veterans Health. Administration.

The results were published in a recent journal Clinical infectious diseases.

As part of the national survey, program managers were asked about things such as key aspects of the current antibiotic management structure and function of their system or network. The researchers also hosted a webinar, virtual panel discussions, and focus groups, which gave them more insight into these antimicrobial stewardship programs, and also inspired leaders in this field to start conversations between them about their work.

The researchers found that there are four categories of programs in the United States:

1. Collaborative model (15%): These programs are developed organically without a formal structure and are managed by committees with limited responsibility. With this model, site participation is voluntary and antimicrobial stewardship goals are defined by individual sites rather than at the system level.

2. Centralized coordination model (30%): These programs have a formal written structure and a committee with some level of system responsibility. This model often forms organically at first, but also includes system-wide stewardship initiatives led by a committee, system-wide goals coordinated by a central committee (and can be supplemented by local goals), data resources often prioritized by the committee.

These programs typically have tools and technology changes coordinated and shared through a central committee; and subject matter expertise, communication and education provide local committee support. In this model, participation is often required.

3. Centrally-led model (40%): These programs have a formal system of AMS stewardship and system accountability with system-level resources. Goals are set by managers at the system level (and can be supplemented by local goals), with system managers responsible for standardized data across sites and benchmarking taking priority.

According to this model, system leaders coordinate tools and technological changes so that they are universally implemented. Expertise, communication and education on the subject are often provided at the system level and reinforced at the local level as well. As with centrally coordinated models, participation is often required.

4. Collaborative and consultative network model (10%). These programs, where antimicrobial stewardship leaders from outside the organization serve as consultants, mentors, or members in collaboration with onsite stewards, allow sites to participate and receive support from a network. This model also includes site-specific mentoring, goals, management, and tools adopted from external sites; data and communication technologies developed locally or via the system network; and subject matter expertise and education provided by external leaders as well.

Understanding antimicrobial stewardship programs in integrated health systems becomes increasingly critical as health systems merge and grow. In 2018, for example, about 75% of hospitals in the United States and 90% of hospital beds were affiliated with a health system, Dr. Stenehjem said.

“In addition to growing health systems, they’re also partnering with similar electronic health record platforms and trying to streamline resources,” Buckel said. “Every healthcare system is federally mandated to have an antibiotic stewardship program, and everyone has worked hard to meet the minimum. Now we’re trying to show how to improve that if they don’t already have it.” do.”

Next, the researchers hope to use these categories to begin studying which models are most effective for which types of health systems. This study also focused largely on hospital care practices, and the researchers hope to extend their work to antibiotic prescribing activity in ambulatory settings, such as urgent care clinics and doctor’s offices. .

“We hope that bringing these groups together and starting to learn more about how we all approach antimicrobial stewardship is the start of a call to action and will also lead health systems to prioritize and fund programs for centrally directed management,” Dr. Stenehjem said. “It improves our patient care and at the same time benefits the overall health of our communities.”

Provided by Intermountain Healthcare