Clinical Metrics for a Large Healthcare System’s Antimicrobial Management Program

Background: Clinical metrics and outcomes for evaluation of antimicrobial management programs (AMP) are challenging and inconsistent throughout the United States. Here, we present the results of the development of clinical metrics to measure and trend AMP outcomes within 161 acute-care facilities affiliated with a large healthcare system. Methods: Key AMP metrics were implemented in 2018 using 2017 as baseline: use of fluoroquinolones in UTIs, dosing of vancomycin, de-escalation, and intravenous (IV)-to-oral conversion of targeted drugs. Fluoroquinolone (FQ) and UTI metric evaluated all inpatients who received at least 1 dose of a FQ based on barcoded medication administration (BCMA) data and urinary tract infections were based on cystitis ICD-10 coding. Vancomycin dosing metric evaluated inpatient vancomycin troughs within therapeutic range during the admission. De-escalation metric evaluated for patients on a broad-spectrum antibiotic with a positive culture and sensitivity to narrower antibiotics. The IV-to- o ral ratio was used to monitor targeted medications. Nonantimicrobial medications appropriate for IV-to- oral conversion were included in the ratio. Goals were established for each metric using the 75 th percentile and ranges for “at goal,” “close to goal,” and “not at goal” were established using green–yellow–red color coding. Metrics were monitored via a systemwide dashboard that included all affiliated facilities. Data were shared monthly to key stakeholders including physicians, pharmacists, and senior leadership. Results: From 2017 to the third quarter of 2019, the FQ and UTI metric decreased 55%. This reduction in the FQ usage in UTI metric correlated with a reduction of 26.7 days of therapy (DOT) per 1,000 days present for FQ and a 50% reduction in FQ DOT for all affiliated facilities. The vancomycin dosing metric improved 2.9% from 75.2% of patients to 78.1% of patients with at least 1 vancomycin trough within range during the admission, which represents ~2,000 more patients with dosing in the target range over baseline. The de-escalation metric improved by 7% overall from 2018 to the third quarter of 2019, which translates to ~1,600 more patients with therapy de-escalated. The IV-to-oral ratio metric improved 5.5%, which means that ~180,000 more oral dosages were administered. Conclusions: Implementing AMP program clinical metrics in a large health system positively influenced antimicrobial medication therapy management for patients. Monit