Strategies for Improving Antimicrobial Use and the Role of Antimicrobial Stewardship Programs
Thomas M. File Jr
()
1
2
3
Joseph S. Solomkin
0
2
Sara E. Cosgrove
2
4
0
Department of Surgery, University of Cincinnati College of Medicine
, Cincinnati,
Ohio
1
Department of Internal Medicine, Infectious Disease Service, Summa Health System
, Akron,
Ohio
2
Disease Service, Summa Health System
, 75 Arch St, Ste 506, Akron,
OH 44304
3
Department of Internal Medicine, Infectious Disease Section, Northeastern Ohio Universities, Colleges of Medicine and Pharmacy
, Rootstown,
Ohio
4
Department of Medicine, Division of Infectious Diseases, Antibiotic Management Program, Johns Hopkins Medical Institutions
,
Baltimore, Maryland
CENTERS FOR MEDICARE AND MEDICAID SERVICES PERFORMANCE MEASURES AND QUALITY OF CARE INITIATIVES Improving Antimicrobial Use Through Antimicrobial Stewardship Programs d CID 2011:53 (Suppl 1) d S15
-
To evaluate the quality of patient care in specific disease
states, the Centers for Medicare and Medicaid Services
(CMS) tracks hospital adherence to specific
evidencebased performance measures. The performance
measures are processes of care for which there is a strong link
between the process and patient outcomes; they
provide objective evaluations of hospital performance
and patient care. Currently, CMS supports initiatives
in several areas: heart failure, myocardial infarction,
community-acquired pneumonia (CAP), and
postsurgical complications (through the Surgical Care
Improvement Project [SCIP]). CMS performance
measures, as well as other quality-improvement
initiatives, work synergistically with antimicrobial
stewardship programs (ASPs), which are also strategies for
improving drug use and patient care. Like ASPs, core
performance strategies, among other goals, promote
appropriate antimicrobial selection and use. Thus,
performance measures can bolster the influence of ASPs,
and ASPs can facilitate the implementation of
performance measures. This article reviews CAP performance
measures, SCIP, and strategies for genitourinary
infections, and their intersection with ASPs.
To evaluate the quality of patient care and provide
objective means to assess improvement in care in specific disease
states, the Centers for Medicare and Medicaid Services
(CMS) tracks hospital adherence to specific,
evidencebased performance measures. The performance measures
are processes of care for which there is a strong link
between the process and patient outcomes [1, 2].
Performance measures are based on processes of care
(eg, choice of diagnostic studies or antimicrobials),
which are encounters between patients and health care
workers (HCW) that are tangible, quantitative, and
within the control of the HCW. They are based on
evidence-based guidelines; as such they provide objective
evaluations of hospital performance and patient care.
Process of care measures are unlike measurements of
patient outcomes, which are often dependent on factors
outside the control of the HCW (eg, patients comorbid
status, lifestyle choices, and adherence to prescribed
medications) [1]. Currently, CMS supports quality
improvement initiatives in several resource-intensive
diseases: heart failure, myocardial infarction,
communityacquired pneumonia (CAP), and prevention of
postsurgical complications (the Surgical Care Improvement
Project [SCIP]).
Ideally, CMS performance measures, as well as other
quality improvement initiatives, should work
synergistically with antimicrobial stewardship programs (ASPs),
which are, in themselves, strategies for improving drug
use and patient care. Like ASPs, core performance strategies, in
addition to promoting smoking cessation counseling,
vaccination, and education, are designed to promote appropriate
antimicrobial selection and use. Thus, performance measures
issued and supported by government agencies and/or
professional societies can help bolster the influence of ASPs and
ASPs, in turn, can facilitate and control the implementation of
performance measures.
COMMUNITY-ACQUIRED PNEUMONIA:
CENTERS FOR MEDICARE AND MEDICAID
SERVICES CORE PERFORMANCE MEASURES
In 2007, pneumonia/influenza was the eighth leading cause of
death in the United States, accounting for 52 717 deaths or 2.2%
of all deaths and 1.1 million hospital discharges [3, 4]. Although
this represented a 9% decrease in deaths from 2006, the crude
pneumonia/influenza-associated mortality rate was,
nevertheless, 17.5 per 100 000 population. The economic burden
associated with CAP remains substantial at $17 billion annually in
the United States [5].
The current CMS performance measures for CAP include blood
cultures, timely antimicrobial therapy, appropriate antimicrobial
selection, smoking cessation, vaccination, and measuring mortality
(Table 1) [3]. The recommendations are based on the most recent
Infectious Diseases Society of America (IDSA)/American
Thoracic Society (ATS) CAP guidelines, and some are used to
determine hospital eligibility for reimbursement (Table 1).
The implementation of performance measures is variable, and
there is a (...truncated)