Metrics in antibiotic stewardship

75 Pages·2014·2.47 MB·English

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Metrics in antibiotic stewardship:
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structure, processL and orutcomes
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Jeroen Schouten
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Internist-intensivist, CWZ Nijmegen
IQ Healthcare, Radboudumc
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Importance of metrics?
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• Quality assurance; monitor the effecct of an (Antibiotic
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Stewardship) intervention
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• Continual improvementi in clinical care (PDSA)
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• Comparisons
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– Intrahospital (units, services)
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– Interhospital (benchmarking)
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• Justify cost of antimicrobial stewardship programs (ASPs)
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Quality of antibiotic use
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What defines ‘appropriate antibiotic use’?
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and how can you measure it?
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Is Quality measurable?
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Quality is measurable!
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Quality of hospital care: measuraable?
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What do I want to measure?
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Definition Quality Indicator:

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A measurable elemenlt of practice performance for which there
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is evidence or consensus thayt it can be used to assess the
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quality, and hence chan ge the quality of care provided …
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Lawrence, 1997
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What do I want to measure?
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• Different types of indicators
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– process
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– outcome o

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– structure
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• Use is dependDent on sta keholder: doctors, Health Care
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Insurance and Inspectorate, patient organisations etc (QI
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project, performance, control,…)
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What do I want to measure?
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• 1. Validity
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– Scientific evidence e

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– Consensus
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– Systematic procnedure t
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• 2. Validity not enougbh: indicator should be applicable in
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– Feasibility
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– Opportunity for improvement
– Case-mix stability
Campbell, BMJ, 2003; Rubin, Int J Qual Health Care, 2001
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How to develop QI’s?
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