Study Highlights Diverse Approaches to Improving Antibiotic Use

U.S. health systems can play an important role in expanding antibiotic stewardship efforts, fighting superbugs

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Study Highlights Diverse Approaches to Improving Antibiotic Use
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A new study published in Clinical Infectious Diseases offers a first-of-its-kind, systematic look at antibiotic stewardship programs in health systems and networks across the U.S. The findings highlight both shared traits and key differences across a spectrum of implementation strategies and underscore that there is no one-size-fits-all approach.

Researchers from The Pew Charitable Trusts, Intermountain Healthcare, and the University of Utah gathered information—through a questionnaire and series of focus groups—from a diverse group of 20 health systems and networks on how they have implemented antibiotic stewardship efforts. Based in Salt Lake City, Intermountain is the largest health care provider in the Intermountain West states and a leader in stewardship efforts.

The study identified four distinct models of antibiotic stewardship programs (see Table 1) and six common categories of core stewardship activities. Antibiotic stewardship, which refers to efforts aimed at improving the use of these lifesaving drugs, is essential to combating the growing threat of drug-resistant bacteria and improving patient safety.

Health Systems Take a Range of Approaches to Antibiotic Stewardship

Study identifies 4 models for systemwide efforts to improve prescribing

Model Description
  • No formal structure
  • Stewardship committee with limited accountability
  • Often formed organically
Centrally coordinated
  • Formal written structure
  • Committee with at least some system accountability
  • Often formed organically after initial collaborative stage
Centrally led
  • Appointed antimicrobial stewardship leaders within the health system
  • System accountability held by system leaders—for example, through committees or direct reporting relationships
  • Requires system-led resources
Collaborative, consultive network
  • Antimicrobial stewardship leaders from outside of the organization serve as consultants, mentors, or advisers in collaboration with on-site leaders
  • Allows sites to participate in and receive support from a network
  • Provides access to subject-matter experts

Source: Harnessing the Power of Health Systems and Networks for Antimicrobial Stewardship, Clinical Infectious Diseases

The study findings can serve as a resource for health systems and networks as they develop or refine their own stewardship programs. The work also can help them identify key roles and responsibilities for antibiotic stewardship staff. The authors spell out six major categories of health system stewardship activities, each of which helps build a strong program. They are:

  1. Building and leading a stewardship community.
  2. Strategic planning and goal setting.
  3. Developing validated data streams.
  4. Developing and implementing antimicrobial stewardship policies and practices across the health system.
  5. Providing subject-matter expertise.
  6. Serving as a source of information and educational resources for health system stewardship efforts.

Health systems—which often include different types of hospitals and a variety of health care facilities, such as clinics and urgent care centers—are uniquely positioned to lead the expansion of antibiotic stewardship efforts across a diverse range of settings. In 2018, about three-quarters of U.S. hospitals and more than 9 in 10 hospital beds were affiliated with a health system, and these systems continue to expand nationwide.

The study highlighted the need to expand stewardship efforts across all health care settings found within health systems. Although the systems and networks that participated had all implemented stewardship practices in the hospitals, fewer had done so in their outpatient facilities. Given that the majority (80% to 90%) of antibiotic prescribing in the U.S. happens in the outpatient setting and as many as half of those prescriptions may be inappropriate, this highlights a significant opportunity for health systems to help decrease costs and improve patient care through expanded stewardship efforts.

With this opportunity in mind, Pew, working with health systems, public health leaders, and policymakers, plans to explore further how health systems across the U.S. can leverage their shared resources and expertise to help improve antibiotic prescribing in their affiliated outpatient facilities.

David Hyun, M.D., is project director and Rachel Zetts, MPH, is a senior officer with The Pew Charitable Trusts’ antibiotic resistance project.

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