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Metrics Selection and Risk Adjustment Methods to Benchmark Inpatient Antibiotic Use.

Michihiko Goto^1,2, Hyunkeun Cho^1,3, James A Merchant^1,4

¹Center for Access and Delivery Research and Evaluation, Iowa City Veterans Affairs (VA) Health Care System, Iowa City.

JAMA Network Open

|June 11, 2025

Summary

This summary is machine-generated.

Risk adjustment models for hospital antibiotic use significantly change benchmarking results when patient-level factors are included. These findings highlight the need for more comprehensive models in antimicrobial stewardship programs.

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Area of Science:

Health Services Research
Infectious Diseases
Health Informatics

Background:

The Centers for Disease Control and Prevention's standardized antimicrobial administration ratio (SAAR) is used for hospital antibiotic use benchmarking.
Current SAAR models do not account for healthcare data's hierarchical nature or patient-level factors, potentially limiting stewardship efforts.

Purpose of the Study:

To evaluate antimicrobial use risk adjustment methods in hospital benchmarking.
To compare basic metrics like days of therapy (DOT) and days of antimicrobial spectrum coverage (DASC) in hospital benchmarking.

Main Methods:

Retrospective cohort study of 736,810 patients across 117 Veterans Health Administration (VHA) acute care hospitals (2021-2023).
Compared three benchmarking methods: unadjusted, risk adjustment with hospital/unit factors (Method 1), and risk adjustment with hospital/unit/patient factors (Method 2).
Utilized negative binomial and hierarchical zero-inflated negative binomial regression models.

Main Results:

Significant variability in unadjusted antibiotic use (DOT and DASC) was observed across hospitals.
Risk adjustment methods (Method 1 and Method 2) led to moderate changes in hospital rankings.
Weak correlations were found between benchmarking results from Method 1 and Method 2 (τB = 0.43 for DOT, 0.44 for DASC).

Conclusions:

Substantial differences in risk-adjusted benchmarking results exist between models using only hospital/unit factors versus those including patient-level factors.
Models incorporating patient-level data may offer higher content validity for assessing hospital and stewardship program performance.
Further research is needed to validate these more comprehensive models and their utility for informing antimicrobial stewardship.