Use of a structured panel process to define quality metrics for antimicrobial stewardship programs

Area of Science:

• Healthcare Quality Improvement
• Infectious Disease Management
• Public Health Policy

Background:

• Antimicrobial stewardship programs aim to reduce inappropriate antimicrobial use, adverse events, Clostridium difficile infection, and antimicrobial resistance.
• A standardized approach is lacking for evaluating the impact of these crucial healthcare programs.

Purpose of the Study:

• To establish quality improvement metrics for antimicrobial stewardship programs using a structured panel process.
• To identify metrics suitable for both internal evaluation and public reporting in hospital settings.

Main Methods:

• A multiphase modified Delphi technique was employed.
• A 10-member expert panel from Canada and the US participated.
• A paper-based survey was supplemented by a 1-day consensus meeting.

Main Results:

• Five final metrics were selected: days of therapy per 1000 patient-days, drug-resistant organism prevalence, antimicrobial-resistant organism-related mortality, conservable days of therapy for specific infections (CAP, SSTI, BSI), and 30-day unplanned readmissions for these infections.
• The first two metrics were also deemed suitable for public reporting and accountability.
• The panel evaluated indicators for relevance, effectiveness, and quality improvement potential.

Conclusions:

• Two public reporting measures and five internal quality indicators for antimicrobial stewardship programs were successfully identified.
• These indicators can be implemented across healthcare systems for ongoing evaluation and improved patient safety.
• The defined metrics support the assessment of antimicrobial stewardship program effectiveness and complement patient safety initiatives.