14 - outcomes from the AHRQ Safety Program for Improving Antibiotic Use Across 439 Long-term Care Facilities

Background: Implementing effective antibiotic stewardship programs (ASPs) in long-term care (LTC) settings is challenging. We present the results of an intervention intended to change the culture of antibiotic prescribing in 439 United States LTC facilities (LTCF).

Methods: The LTC Safety Program assisted LTCFs with establishing and implementing ASPs from 12/2018 to 11/2019. Through webinars held 1-2 times per month and other educational content, the Safety Program emphasized 1) the science of safety to improve teamwork and identify antibiotic-associated harm and 2) clinical best practices in making antibiotic treatment decisions. Content was organized using the Four Moments of Antibiotic Decision Making Framework (Figure 1). All staff (e.g., physicians, nurses, nurse assistants) were encouraged to participate. LTCFs submitted monthly antibiotic days of therapy (DOT), numbers of new antibiotic starts, urine cultures (UCX) ordered, Clostridioides difficile LabID events, and census data. Generalized linear mixed effects models were used to calculate pre-post intervention changes at bi-monthly intervals for antibiotic DOT, antibiotic starts and UCX, each per 1,000 resident-days (RD), and C. difficile LabID events per 10,000 RD, comparing the beginning (1/2019 and 2/2019) and end (11/2019 and 12/2019) of the Safety Program. Figure 1. Four Moments of Antibiotic Decision Making in the Long-Term Care Setting


Results: Of 439 LTCFs who completed the Safety program, the majority were mid-sized (75-149 beds; 229, 52.2%), most were non-hospital based and owned by a larger system (246, 56.0%), with similar distributions between urban and rural settings. Of these, 348 (79%) submitted both baseline and end-of-intervention data. Antibiotic starts decreased from 7.89 to 7.48 starts/1000 RD; P = 0.02). Days of therapy for all antibiotics decreased from 64.1 to 61.0 DOT/1,000 RD; P = 0.068) and for fluoroquinolones (an antibiotic targeted in the Safety Program) from 1.49 to 1.28 DOT/1,000RD; P=0.002. UCX decreased from 3.01 to 2.63 orders/1000 RD; P = 0.001). There were no significant differences in C. difficile LabID events Table 1.Table 1. Changes from baseline (Jan-Feb, 2019) to the end (Nov-Dec, 2019) of the AHRQ Safety Program


Conclusion: By targeting both antibiotic prescribing culture and knowledge of best practices, the AHRQ Safety Program led to significant reductions in antibiotic use across a large cohort of LTCFs. 

Presenting Author(s)

• 

  Morgan Katz, MD, MHS

  Assistant Professor
  Johns Hopkins University
  Baltimore, Maryland

  Disclosure: AHRQ : Research Grant or Support; CDC : Grant/Research Support (Status: Ongoing), Research Grant or Support (Status: Ongoing)

  Slides Slides and Audio

Co-Author(s)

• 

  Theresa Rowe, DO MS

  Assistant Professor of Medicine
  Northwestern University
  Chicago, Illinois

  Disclosure: No Disclosure
• SC

  Sara E Cosgrove, MD, MS

  Professor of Medicine, Division of Infectious Diseases
  Johns Hopkins University of Medicine
  Baltimore, Maryland

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• 

  Pranita Tamma, MD, MHS

  Associate Professor
  Johns Hopkins
  Baltimore, Maryland

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• MM

  Melissa A. Miller, MD, MS

  Physician
  Agency for Healthcare Research and Quality
  Rockville, Maryland

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• PD

  Prashila Dullabh, MD

  Senior Fellow
  NORC at the University of Chicago
  Bethesda, Maryland

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• KS

  Kathleen Speck, MPH

  Research Project Administrator
  Johns Hopkins
  Baltimore, Maryland

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• RA

  Roy Ahn, MPH, ScD

  Vice President, Public Health
  NORC
  Chicago, Illinois

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• YG

  Yue Gao, MPH

  Sr Research Scientist
  NORC
  Bethesda, Maryland

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• ES

  Erik Scherpf, Ph.D.

  Senior Research Methodogist
  NORC at the University of Chicago
  Arlington, Virginia

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• 

  Robin L. Jump, MD, PhD

  Associate Professor of Medicine
  Case Western Reserve University
  Cleveland, Ohio

  Disclosure: Merck : Research Grant or Support (Status: Ongoing); Pfizer () : Advisor or Review Panel member, Research Grant or Support