Year: 2021
Type: article
Abstract: Quality improvement, the systematic process to improve health care delivery, has become ubiquitous in health care.Quality improvement focuses on a modest concept: that we all have room for improvement as clinicians and health systems.The quality improvement literature emphasizes the use of simple interventions, such as checklists and performance reports, to improve health care.Entire departments now exist focused on quality or performance improvement to meet regulatory and accreditation standards with a goal to improve patient outcomes and safety.Quality improvement departments have robust infrastructure including information technology, data scientists, and improvement specialists.This infrastructure supports multiple interprofessional teams focused on improving care of a condition (eg, heart failure) and/or patient safety issue (eg, fall prevention).These teams adapt different approaches to identify strategies to support evidencebased health care and determine intervention effectiveness.Quality improvement departments are necessary to navigate the unique complexities of the facility's implementation context to develop, deploy, and sustain successful interventions.Antimicrobial stewardship is a set of strategies to improve and measure antibiotic prescribing by clinicians and antibiotic use by patients.Antimicrobial stewardship shares many common elements with quality improvement, including identifying what needs to be improved, implementing strategies to improve antibiotic prescribing, focusing on feasible and high-impact interventions, and measuring program outcomes.The ultimate goal of quality improvement and antimicrobial stewardship is also similar: to improve patient safety.Major long-term goals of antimicrobial stewardship are to decrease the development of Clostridioides difficile infection and antimicrobial resistance.Unfortunately, most health systems lack robust infrastructure to support antimicrobial stewardship, with few hospitals providing information technology personnel and salary support for infectious diseases pharmacists and physicians. 1 Without this support, the work to develop, deploy, and determine the effectiveness of antimicrobial stewardship is shouldered by antimicrobial stewardship leaders, few of whom are specialty trained in infectious diseases or program evaluation. 2 Antimicrobial stewardship programs first emerged among high-resource institutions, such as academic medical centers.However, as the importance of the work gained heightened awareness, the establishment of antimicrobial stewardship programs was encouraged or required through public health recommendations, state laws, accreditation requirements, and payor policies.In 2015, the US released the "National Action Plan for Combatting Antibiotic-Resistant Bacteria," which called for all acute care hospitals to implement antimicrobial stewardship programs and prompted the release of the core elements of hospital antibiotic stewardship programs from the Centers for Disease Control and Prevention, 1 as well as a joint guideline by the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America.3 These recommendations subsequently informed accreditation requirements implemented by The Joint Commission, the accrediting body for more than 22 000 US health systems.4 Currently, the National Quality Forum has endorsed Centers for Disease Control and Prevention antibiotic use metrics as quality improvement measures for antibiotic use and the Centers for Medicare & Medicaid Services has proposed a rule tying these measures to reimbursement policy.5 This evolution of regulations, requirements, and guidance has led to the expansion of antimicrobial stewardship programs to most hospitals in the US. 6Within this context of an increasing focus on antimicrobial stewardship implementation nationwide, it is particularly relevant to consider this study by Tamma et al 2 that reports on the success of the largest pragmatic quality improvement antimicrobial stewardship program initiative in +
Source: JAMA Network Open
Language: English
Subfield: Applied Microbiology and Biotechnology
Field: Immunology and Microbiology
Domain: Life Sciences
Open Access status: gold
Estimated APC paid: $3,000
OpenAlex ID: W3130113445