Antibiotic Stewardship- Preserving Today's Antibiotic Armamentarium
One Intermountain and Antibiotic Stewardship SCORE UC
Transcript of One Intermountain and Antibiotic Stewardship SCORE UC
One Intermountain and Antibiotic Stewardship – SCORE UC
February 2020ECHO - EASIE
Eddie Stenehjem, MD MScMedical Director of Antibiotic Stewardship Office of Patient Experience
Disclosures
I receive funding from CDC and AHRQ for antibiotic stewardship implementation research.
I am part of an advisory panel for Becton Dickson (BD) providing content expertise on diagnostic stewardship.
Objectives
1. Describe why Urgent Care Stewardship is needed.
2. Describe how and why the urgent care antimicrobial stewardship campaign has been successful.
Antibiotic Stewardship at Intermountain Healthcare
Large Hospital/TraumaCenterHospital
InpatientRehab
Skilled NursingFacility
OutpatientRehab
HomeHealth
SpecialtyClinic
Urgent CareClinic
TeleHealth
Home
Retail Pharmacy
PrimaryCare Clinic
Safest, highest quality, most affordable care for serious injury and illness
COMMUNITY-BASED CARE SPECIALTY-BASED CARE
>50% of outpatient antibiotics
Background:
• Rapidly growing sector of outpatient care delivery
• Inappropriate antibiotic prescribing may be higher than other settings
0
2000
4000
6000
8000
10000
2014 2015 2016 2017 2018 2019
Urgent Care Centers in the US
Palms, et al. JAMA Intern Med. 2018 Sep 1; 178(9)
45.7%
24.6%17% 14.4%
Intermountain’s Respiratory Antibiotic Prescribing Rate
Stenehjem E, Wallin A, Fleming-Dutra, KE, et al. Clinical Infectious Diseases. 2019.
SCORE UC Objective
Improve respiratory antibiotic prescribing in our urgent care network by implementing a comprehensive outpatient stewardship program.
Primary Target:
• Respiratory prescribing
Funded by CDC SHEPheRD Contract.
Stewardship in Community Outpatient settings - Resources and Engagement - Urgent Care
SCORE-UC Interventions
• Education – Clinicians• Education – Patients• iCentra tools• Transparent Data• Media
*All based on patient/provider interviews and observations done before the intervention
Interventions: Clinician Education
• CPMs updated
• Regional UC monthly meetings
• Blog posts/Podcasts
• Site visits
• Clinic materials
9
Interventions: Patient Education -https://printit.intermountain.net/
10
Intervention: Accessible data with peer comparison
Accessible:
1. Shortcut in iCentra
2. https://intermountainhealthcare.org/antibiotics
3. Intermountain.net: “abx” → tracking and reporting → Urgent Care Outpatient Provider Report
4. Save link as a favorite in browser
12
Respiratory Prescribing Metrics
Primary Measure:
1. Respiratory encounter prescribing rate
Secondary measures:
2. Delayed prescribing use for sinusitis/OM/pharyngitis
3. First line therapy use for sinusitis/OM/pharyngitis
4. Respiratory “Tier 3” antibiotic prescribing rate
Respiratory encounter antibiotic prescribing rate
Definition: Respiratory encounter with antibiotic prescribed Total Respiratory encounters
Respiratory Encounter: An encounter with a billed respiratory ICD10 code
Why we use this: • Agnostic of coding practices• Large number of encounters – common encounter type • Significant variation is present
Intervention: Media
• Commitment Posters
• Clinic messaging
• Traditional & social media
• Raising awareness and changing patient perceptions before they see the clinician
21
Collaborative Effort with Focus
• CBC/Urgent Care Leadership• OPE/AS team• CTIS• Healthcare Delivery Institute• Office of Research• Continuous Improvement• Media and PPP Team• Pharmacy
23
Virtual Care
People in Our Communities
InpatientOutpatient Executive Leadership Team
STRATEGY
ACOO | ACNO | ACMOACOO | ACNO | ACMO
Clinical Programs
Research & Academics
Shared Support Services
SelectHealth | Aligned Payers
ACOO
Intermountain Foundation
Medical Group | Affiliated Network
Shared Clinical Services
50% → 33%17,000 Abx scripts avoided120,000 days of avoided
52%
47%
51% 51% 51%52%
49%
45%
49%
51%53%
51%
44%
40%38%
40%
37%37%
33%
20%
25%
30%
35%
40%
45%
50%
55%
Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18 Jan-19 Feb-19 Mar-19 Apr-19 May-19 Jun-19 Jul-19 Aug-19 Sep-19 Oct-19 Nov-19 Dec-19 Jan-20
Intervention Starts• Data• Media• EHR Tools• Education
Respiratory prescribing rate – Urgent Care
What’s next for antibiotic stewardship?
• Continue support urgent care efforts
• New antibiotic prescribing culture and standard
• Support FM/IM/Peds in their stewardship goals
• Work with SelectHealth in targeting affiliated clinics
• Developing a Utah community of antibiotic stewards
Questions?
Eddie Stenehjem, MD MSc
Medical Director, Antibiotic Stewardship
Intermountain Healthcare
Salt Lake City, UT
@E_Stenehjem