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Comparison of Prior Authorization and Prospective Audit with Feedback for Antimicrobial Stewardship

Published online by Cambridge University Press:  10 May 2016

Jimish M. Mehta ,
Kevin Haynes ,
E. Paul Wileyto ,
Jeffrey S. Gerber ,
Daniel R. Timko ,
Steven C. Morgan ,
Shawn Binkley ,
Neil O. Fishman ,
Ebbing Lautenbach  and
Theoklis Zaoutis
Jimish M. Mehta*
Affiliation:
Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
Kevin Haynes
Affiliation:
Department of Biostatistics and Epidemiology, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
E. Paul Wileyto
Affiliation:
Department of Biostatistics and Epidemiology, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
Jeffrey S. Gerber
Affiliation:
Division of Infectious Diseases, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
Daniel R. Timko
Affiliation:
Department of Pharmacy, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
Steven C. Morgan
Affiliation:
Department of Pharmacy, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
Shawn Binkley
Affiliation:
Department of Pharmacy, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
Neil O. Fishman
Affiliation:
Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
Ebbing Lautenbach
Affiliation:
Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania Department of Biostatistics and Epidemiology, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
Theoklis Zaoutis
Affiliation:
Division of Infectious Diseases, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania Department of Biostatistics and Epidemiology, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
*
Department of Pharmacy, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104 (mehtaj@mail.med.upenn.edu).
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Extract

(See the commentary by Van Schooneveld and Rupp, on pages1100–1102.)

Objective

Although prior authorization and prospective audit with feedback are both effective antimicrobial stewardship program (ASP) strategies, the relative impact of these approaches remains unclear. We compared these core ASP strategies at an academic medical center.

Design

Quasi-experimental study.

Methods

We compared antimicrobial use during the 24 months before and after implementation of an ASP strategy change. The ASP used prior authorization alone during the preintervention period, June 2007 through May 2009. In June 2009, many antimicrobials were unrestricted and prospective audit was implemented for cefepime, piperacillin/tazobactam, and vancomycin, marking the start of the postintervention period, July 2009 through June 2011. All adult inpatients who received more than or equal to 1 dose of an antimicrobial were included. The primary end point was antimicrobial consumption in days of therapy per 1,000 patient-days (DOT/1,000-PD). Secondary end points included length of stay (LOS).

Results

In total, 55,336 patients were included (29,660 preintervention and 25,676 postintervention). During the preintervention period, both total systemic antimicrobial use (−9.75 DOT/1,000-PD per month) and broad-spectrum anti-gram-negative antimicrobial use (−4.00 DOT/1,000-PD) declined. After the introduction of prospective audit with feedback, however, both total antimicrobial use (+9.65 DOT/1,000-PD per month; P < .001) and broad-spectrum anti-gram-negative antimicrobial use (+4.80 DOT/1,000-PD per month; P < .001) increased significantly. Use of cefepime and piperacillin/tazobactam both significantly increased after the intervention (P = .03). Hospital LOS and LOS after first antimicrobial dose also significantly increased after the intervention (P = .016 and .004, respectively).

Conclusions

Significant increases in antimicrobial consumption and LOS were observed after the change in ASP strategy.

Infect Control Hosp Epidemiol 2014;35(9):1092-1099

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 35 , Issue 9 , 01 September 2014 , pp. 1092 - 1099
Copyright
© 2014 by The Society for Healthcare Epidemiology of America. All rights reserved.

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