Hospitals are increasingly mandated to have antimicrobial stewardship (AS) programs, but little is known about what AS structures and processes predict effective antibiotic use. We used data from a 2012 VA-wide AS survey to determine relationships between AS characteristics of individual facilities and antibiotic use.
The VA Healthcare Analysis & Informatics Group (HAIG) administered a survey regarding AS policies, attitudes, and practices to 130 VA acute care facilities in 2012; all facilities responded. Because of the high dimensionality of the data, factor analyses were used to identify 32 organizational factors, mapped to the Promoting Action on Research Implementation in Health Services framework: Evidence, Context, and Facilitation. Multi-variable models with LASSO (tuning parameter 0.025) measured associations between factors and antibiotic usage per 1000 patient days during the same year as the survey (2012).
Factors significantly associated with lower antibiotic use included, in order of the magnitude of their association, the presence of postgraduate medical or pharmacy training programs; Infectious Diseases (ID) fellow/attending involvement in antibiotic approvals; presence of condition-specific stewardship interventions (policies for de-escalation, mitigation of antibiotic exposure in patients with Clostridium difficile infection, positive blood culture review, and/or automatic Infectious Diseases (ID) consults for certain conditions); availability of inpatient ID consultation; pharmacy support and ID attendings on acute care teams; facility complexity; ID training of AS pharmacist; and frequency of systematic review for de-escalation. Factors associated with higher antibiotic use included having implemented stop orders; identified institutional challenges to optimal antibiotic use; sought assistance from the national VA stewardship SharePoint site; and involved non-ID physicians in approvals.
Facility factors associated with decreased antibiotic use demonstrated the importance of organizational control and establishment of formalized processes in AS implementation. Facilities with high antimicrobial use appeared to recognize barriers to optimal practice and were more likely to rely on non-ID physicians.
C. J. Graber,
A. F. Chou, None
Y. Zhang, None
M. Bidwell Goetz, None
K. Madaras-Kelly, None
M. Samore, None
P. Glassman, None
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