Quality of antibiotic use for lower respiratory tract infections at hospitals: (how) can we measure it?
BACKGROUND
To assess and improve the quality of antibiotic use in patients with community-acquired pneumonia (CAP) and acute exacerbation of chronic bronchitis or chronic obstructive pulmonary disease (AECB), a valid set of quality indicators is required. This set should also be applicable in practice.


METHODS
Guidelines and literature were reviewed to derive potential indicators for quality of antibiotic use in treating hospitalized patients with lower respiratory tract infection (LRTI). To assess the evidence base of each indicator, a literature review was performed. Grade A recommendations were considered valid. For grade B-D recommendations, an expert panel performed a consensus procedure on the indicator's relevance to patient health, reduction of antimicrobial resistance, and cost containment. To test applicability in practice, feasibility, opportunity for improvement, reliability, and case-mix stability were determined for a data set of 899 hospitalized patients with LRTI.


RESULTS
None of the potential indicators from guidelines and literature were supported by grade A evidence. Nineteen indicators were selected by consensus procedure (12 indicators for CAP and 7 indicators for AECB). Lack of feasibility and of opportunity for improvement led to the exclusion of 4 indicators. A final set of 15 indicators was defined (9 indicators for CAP and 6 indicators for AECB).


CONCLUSIONS
A valid set of quality indicators for antibiotic use in hospitalized patients with LRTI was developed by combining evidence and expert opinion in a carefully planned procedure. Subjecting indicators to an applicability test is essential before using them in quality-improvement projects. In our demonstration setting, 4 of the 19 indicators were inapplicable in practice.
Schouten
J A
JA
Centre for Quality of Care Research, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. J.Schouten@aig.umcn.nl
Hulscher
M E J L
ME
Wollersheim
H
H
Braspennning
J
J
Kullberg
B J
BJ
van der Meer
J W M
JW
Grol
R P T M
RP
D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D032921:Consensus; D004363:Drug Utilization / Q000592:standards / Q000706:statistics & numerical data; D019317:Evidence-Based Medicine; D006761:Hospitals / Q000592:standards* / Q000706:statistics & numerical data; D006801:Humans; D009426:Netherlands; D010043:Outcome and Process Assessment, Health Care; D017410:Practice Guidelines as Topic; D012141:Respiratory Tract Infections / Q000188:drug therapy*
D000900:Anti-Bacterial Agents