Using hospital network-based surveillance for antimicrobial resistance as a more robust alternative to self-reporting

Area of Science:

• Infectious Disease Epidemiology
• Healthcare Quality Improvement
• Public Health Surveillance

Background:

• Current hospital performance metrics rely on self-reported data for hospital-transmitted microorganisms and antimicrobial resistance (AMR).
• Increased screening for AMR can paradoxically lead to poorer performance metrics, discouraging essential testing and hindering infection control.
• This creates a disincentive for hospitals to enhance their surveillance capabilities.

Purpose of the Study:

• To propose and evaluate a novel surveillance system for estimating antimicrobial resistance (AMR) incidence.
• To separate the reporting of incidence from direct performance improvement tasks within hospitals.
• To align incentives for increased screening efforts and improve the comparability of AMR data across hospitals.

Main Methods:

• Proposed a surveillance system where hospitals test patients previously discharged from other facilities and report observed cases.
• Utilized English National Health Service (NHS) Hospital Episode Statistics data to analyze patient movements across England.
• Assessed the participation level of hospitals (41 out of 155) required for robust incidence estimation, with each screening at least 1000 readmissions.

Main Results:

• The proposed system can estimate AMR incidence across all hospitals, even with partial participation (41/155 hospitals).
• Over 1.2 million annual readmissions provide a substantial data pool for the surveillance system.
• Separating incidence reporting from internal performance improvement aligns incentives to encourage, rather than discourage, screening.

Conclusions:

• The proposed surveillance system effectively separates incidence reporting from hospital performance, mitigating disincentives for screening.
• This model promotes more accurate and comparable data on antimicrobial resistance (AMR) across healthcare settings.
• Implementation can lead to improved infection control strategies and better management of AMR challenges in hospitals.