Quality Metrics for Antimicrobial Stewardship Programs.

Anti-Bacterial Agents / therapeutic use Antimicrobial Stewardship / organization & administration Bacterial Infections / diagnosis Canada Consensus Delphi Technique Female Hospitals, Pediatric / statistics & numerical data Humans Male Practice Guidelines as Topic Program Evaluation Quality Improvement Risk Assessment Surveys and Questionnaires Treatment Outcome

Journal

Pediatrics
ISSN: 1098-4275
Titre abrégé: Pediatrics
Pays: United States
ID NLM: 0376422

Informations de publication

Date de publication:
04 2019
Historique:
accepted: 16 01 2019
pubmed: 31 3 2019
medline: 8 11 2019
entrez: 31 3 2019
Statut: ppublish

Résumé

Antimicrobial stewardship programs (ASPs) are targeted to optimize antimicrobial use. However, pediatric metrics used to measure outcomes of ASPs are not well established. Our aim for this project was to identify, refine, and develop consensus on standard metrics for pediatric ASPs. By using a modified Delphi process, 2 surveys were sent to experts and stakeholders to establish consensus on the utility of metrics. These were subdivided into 4 ASP domains: (1) antimicrobial consumption, (2) microbiologic outcomes, (3) clinical outcomes, and (4) process measures. Respondents were asked to rank the scientific merit, impact, feasibility, and accountability of each metric. Metrics with ≥75% agreement for scientific merit were included and metrics with ≤25% agreement were discarded. Consensus was finalized with a face-to-face meeting and final survey. Thirty-eight participants from 15 pediatric hospitals across Canada completed all 3 rounds of the Delphi survey. In the domain of antimicrobial consumption, the 2 selected metrics were (1) days of therapy per 1000 patient-days and (2) total antimicrobial days. The clinical and process outcomes chosen were (1) 30-day readmission rate and (2) adherence to ASP recommendations, respectively. A microbiologic outcome was felt to be important and feasible, but consensus could not be obtained on a measure. Several barriers to implementation of the metrics were identified, including information technology limitations at various centers. We obtained consensus on 4 metrics to evaluate pediatric antimicrobial stewardship activities in Canada. Adoption of these metrics by pediatric ASPs will facilitate measurement of outcomes nationally and internationally.

Sections du résumé

BACKGROUND
Antimicrobial stewardship programs (ASPs) are targeted to optimize antimicrobial use. However, pediatric metrics used to measure outcomes of ASPs are not well established. Our aim for this project was to identify, refine, and develop consensus on standard metrics for pediatric ASPs.
METHODS
By using a modified Delphi process, 2 surveys were sent to experts and stakeholders to establish consensus on the utility of metrics. These were subdivided into 4 ASP domains: (1) antimicrobial consumption, (2) microbiologic outcomes, (3) clinical outcomes, and (4) process measures. Respondents were asked to rank the scientific merit, impact, feasibility, and accountability of each metric. Metrics with ≥75% agreement for scientific merit were included and metrics with ≤25% agreement were discarded. Consensus was finalized with a face-to-face meeting and final survey.
RESULTS
Thirty-eight participants from 15 pediatric hospitals across Canada completed all 3 rounds of the Delphi survey. In the domain of antimicrobial consumption, the 2 selected metrics were (1) days of therapy per 1000 patient-days and (2) total antimicrobial days. The clinical and process outcomes chosen were (1) 30-day readmission rate and (2) adherence to ASP recommendations, respectively. A microbiologic outcome was felt to be important and feasible, but consensus could not be obtained on a measure. Several barriers to implementation of the metrics were identified, including information technology limitations at various centers.
CONCLUSIONS
We obtained consensus on 4 metrics to evaluate pediatric antimicrobial stewardship activities in Canada. Adoption of these metrics by pediatric ASPs will facilitate measurement of outcomes nationally and internationally.

Identifiants

DOI: 10.1542/peds.2018-2372 PMID: 30926619
pubmed: 30926619
pii: peds.2018-2372
doi: 10.1542/peds.2018-2372
pii:
doi:

Substances chimiques

Anti-Bacterial Agents 0

Types de publication

Journal Article Multicenter Study Research Support, Non-U.S. Gov't

Langues

eng

Sous-ensembles de citation

IM

Subventions

Organisme : CIHR
ID : 345372
Pays : Canada

Informations de copyright

Copyright © 2019 by the American Academy of Pediatrics.

Déclaration de conflit d'intérêts

POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.

Auteurs

Michelle Science (M)

Division of Infectious Diseases and michelle.science@sickkids.ca.
Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.

Kathryn Timberlake (K)

Department of Pharmacy, The Hospital for Sick Children, Toronto, Ontario, Canada.

Andrew Morris (A)

Division of Infectious Diseases, Sinai Health System, Toronto, Ontario, Canada.
Department of Medicine, University Health Network, Toronto, Ontario, Canada; and.

Stanley Read (S)

Division of Infectious Diseases and.
Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.

Nicole Le Saux (N)

Division of Infectious Diseases, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.

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Classifications MeSH

questionsmedicales.fr › Actions chimiques et utilisations › Actions pharmacologiques › Utilisations thérapeutiques › Anti-infectieux › Antibactériens › Quality Metrics for Antimicrobial Stewardship Programs.
questionsmedicales.fr › Qualité, accès, évaluation des soins de santé › Assurance de la qualité des soins de santé › Bilan opérationnel › Revue des pratiques de prescription des médicaments › Gestion responsable des antimicrobiens › Quality Metrics for Antimicrobial Stewardship Programs.
questionsmedicales.fr › Infection › Infections bactériennes et mycoses › Infections bactériennes › Quality Metrics for Antimicrobial Stewardship Programs.
questionsmedicales.fr › Régions géographiques › Amériques › Amérique du Nord › Canada › Quality Metrics for Antimicrobial Stewardship Programs.
questionsmedicales.fr › Phénomènes psychologiques › Processus mentaux › Pensée (activité mentale) › Prise de décision › Consensus › Quality Metrics for Antimicrobial Stewardship Programs.
questionsmedicales.fr › Sciences de l'information › Analyse des systèmes › Méthode Delphi › Quality Metrics for Antimicrobial Stewardship Programs.
questionsmedicales.fr › Établissements, main d'oeuvre et services de soins de santé › Établissements de santé › Hôpitaux › Hôpitaux spécialisés › Hôpitaux pédiatriques › Quality Metrics for Antimicrobial Stewardship Programs.
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Quality Metrics for Antimicrobial Stewardship Programs.
questionsmedicales.fr › Qualité, accès, évaluation des soins de santé › Assurance de la qualité des soins de santé › Recommandations comme sujet › Guides de bonnes pratiques cliniques comme sujet › Quality Metrics for Antimicrobial Stewardship Programs.
questionsmedicales.fr › Qualité, accès, évaluation des soins de santé › Qualité des soins de santé › Mécanismes d'évaluation des soins de santé › Évaluation de programme › Quality Metrics for Antimicrobial Stewardship Programs.
questionsmedicales.fr › Administration des services de santé › Amélioration de la qualité › Quality Metrics for Antimicrobial Stewardship Programs.
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Statistiques comme sujet › Probabilité › Risque › Appréciation des risques › Quality Metrics for Antimicrobial Stewardship Programs.
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Collecte de données › Enquêtes et questionnaires › Quality Metrics for Antimicrobial Stewardship Programs.
questionsmedicales.fr › Qualité, accès, évaluation des soins de santé › Qualité des soins de santé › Mécanismes d'évaluation des soins de santé › Évaluation des résultats et des processus en soins de santé › Évaluation de résultat (soins) › Résultat thérapeutique › Quality Metrics for Antimicrobial Stewardship Programs.