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Electronic Clinical Quality Measures of Antibiotic Use in Hospitalized Adults With Uncomplicated Community-Acquired
Andrea T White1, Matthew Bidwell Goetz2, Makoto Jones3
1Division of General Internal Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA.
Background:
Community-acquired pneumonia (CAP) is the top indication for inpatient antibiotic use and overuse. We describe the development of 2 electronic clinical quality measures (eCQMs) assessing the percentage of hospitalized patients with uncomplicated CAP who had unsupported antibiotic duration beyond 5 days and empiric antibiotics targeting methicillin-resistant Staphylococcus aureus and/or Pseudomonas aeruginosa.
Methods:
Both eCQMs were developed based on clinical guidelines, literature, and expert feedback and then specified electronically. The eCQMs were applied to patient data from 2 academic medical centers and 109 Department of Veterans Affairs (VA) healthcare systems to evaluate importance, reliability, validity, and feasibility, as defined by the Centers for Medicare and Medicaid Services.
Results:
Across all hospitals, the mean percentage of eligible patients with unsupported excess duration and inappropriate empiric antibiotic use ranged from 40% to 55% and from 17% to 56%, respectively. Within the VA cohort, reliability (median [first-tenth decile, n]) for duration and empiric eCQMs was high: 93% (63%-97%, 28 238) and 91% (63%-96%, 47 034), respectively. When compared to chart review at 1 academic hospital, both eCQMs had high sensitivity (96%, both) and specificity (92% and 93% for duration and empiric eCQMs, respectively). Feasibility was maximized by using only data elements in structured electronic health record fields. Some technically complex elements (eg, clinical stability) were retained for face validity.
Conclusions:
Two eCQMs identifying unsupported excess antibiotic duration and inappropriately broad empiric antibiotic use in patients with uncomplicated CAP had high importance, reliability, validity, and feasibility. These eCQMs could be benchmarked to assist antibiotic stewardship programs in understanding and improving their antibiotic use.
Insights
Two new electronic quality measures (eCQMs) effectively identify unnecessary antibiotic duration and broad-spectrum antibiotic use in community-acquired pneumonia (CAP) patients, aiding antibiotic stewardship.
Area of Science:
- Healthcare Quality Improvement
- Infectious Disease Management
- Health Informatics
Background:
- Community-acquired pneumonia (CAP) is a leading cause of inpatient antibiotic use and overuse.
- Development of electronic clinical quality measures (eCQMs) is crucial for optimizing antibiotic prescribing.
- Overuse of antibiotics in CAP contributes to antimicrobial resistance and adverse events.
Purpose of the Study:
- To develop and validate two eCQMs for assessing antibiotic use in uncomplicated CAP.
- To evaluate the percentage of patients receiving unsupported antibiotic duration beyond 5 days.
- To assess the use of empiric antibiotics targeting resistant organisms (MRSA, Pseudomonas aeruginosa).
Main Methods:
- eCQMs were developed using clinical guidelines, literature, and expert input.
- eCQMs were electronically specified and applied to patient data from academic medical centers and VA healthcare systems.
- Evaluation included importance, reliability, validity, and feasibility as per CMS criteria.
Main Results:
- Mean unsupported excess antibiotic duration ranged from 40%-55%.
- Mean inappropriate empiric antibiotic use ranged from 17%-56%.
- eCQMs demonstrated high reliability (91-93%), sensitivity (96%), and specificity (92-93%) compared to chart review.
Conclusions:
- Developed eCQMs are important, reliable, valid, and feasible for identifying suboptimal antibiotic use in CAP.
- These eCQMs can benchmark antibiotic prescribing and support antibiotic stewardship programs.
- Implementation of these eCQMs can drive improvements in antibiotic use for CAP patients.
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