title: Evaluation of dedicated infectious diseases pharmacists on antimicrobial stewardship teams.
abstract: OBJECTIVE
  Patient care improvements and cost savings achieved by a large integrated health system through the implementation of antimicrobial stewardship programs (ASPs) at two hospitals are reported.
  
  
  METHODS
  A pre-post analysis was conducted to evaluate cost and quality outcomes at the two ASP sites and three similar sites within the same health system not included in the ASP initiative. The utilization of 15 targeted antimicrobials and associated costs at the five sites during designated preimplementation and postimplementation periods were compared; changes in Hospital Standardized Mortality Ratio (HSMR) values for specific infections among Medicare patients were also assessed.
  
  
  RESULTS
  In the year after ASP implementation, aggregate direct antimicrobial acquisition costs at the two study sites decreased 17.3% from prior-year levels and increased by 9.1% at the three comparator sites. Significant decreases in the consumption of targeted antimicrobial classes (antipseudomonals, quinolones, and agents active against methicillin-resistant Staphylococcus aureus) were observed at the ASP sites. Among the 2446 ASP interventions recorded, 72% involved discontinuing or narrowing the use of broad-spectrum antimicrobials. Although rates of health care-associated Clostridium difficile infection were little changed at both study sites after ASP implementation, HSMR data indicated substantial gains in combating sepsis and C. difficile and respiratory infections.
  
  
  CONCLUSIONS
  After implementation of ASPs at two study sites, the utilization of all classes of antibiotics decreased and antimicrobial costs per 1000 patient-days decreased. While HSMR values for sepsis (including C. difficile-associated cases) and respiratory infections improved, the rate of C. difficile infections stayed the same.
authors.affiliation: Kalvin Yu, M.D., is Regional Chief of Infectious Diseases, Southern California Permanente Medical Group, Kaiser Permanente (KP) West Los Angeles Medical Center, Los Angeles, CA. Jay Rho, Pharm.D., is Senior Director, K P, Pasadena, CA. Marlene Morcos, Pharm.D., is Inpatient Pharmacy Supervisor; and Jim Nomura, M.D., is Chief of Infectious Diseases, KP Los Angeles Medical Center, Los Angeles, CA. Donald Kaplan, Pharm.D., is Inpatient Pharmacy Practice Coordinator, Southern California Region, KP National Pharmacy Programs and Services, Downey, CA. Keith Sakamoto, Pharm.D., is Inpatient Pharmacy Specialist, KP West Los Angeles Medical Center. Doan Bui, Pharm.D., is Inpatient Pharmacy Specialist; and Sandy Yoo, Pharm.D., is Inpatient Pharmacy Specialist, KP Los Angeles Medical Center. Jason Jones, Ph.D., is Executive Director, Clinical Intelligence and Decision Support, KP, Pasadena, CA. kalvin.c.yu@kp.org.
authors.forename: Kalvin
authors.initials: K
authors.lastname: Yu
authors.affiliation: Kalvin Yu, M.D., is Regional Chief of Infectious Diseases, Southern California Permanente Medical Group, Kaiser Permanente (KP) West Los Angeles Medical Center, Los Angeles, CA. Jay Rho, Pharm.D., is Senior Director, K P, Pasadena, CA. Marlene Morcos, Pharm.D., is Inpatient Pharmacy Supervisor; and Jim Nomura, M.D., is Chief of Infectious Diseases, KP Los Angeles Medical Center, Los Angeles, CA. Donald Kaplan, Pharm.D., is Inpatient Pharmacy Practice Coordinator, Southern California Region, KP National Pharmacy Programs and Services, Downey, CA. Keith Sakamoto, Pharm.D., is Inpatient Pharmacy Specialist, KP West Los Angeles Medical Center. Doan Bui, Pharm.D., is Inpatient Pharmacy Specialist; and Sandy Yoo, Pharm.D., is Inpatient Pharmacy Specialist, KP Los Angeles Medical Center. Jason Jones, Ph.D., is Executive Director, Clinical Intelligence and Decision Support, KP, Pasadena, CA.
authors.forename: Jay
authors.initials: J
authors.lastname: Rho
authors.affiliation: Kalvin Yu, M.D., is Regional Chief of Infectious Diseases, Southern California Permanente Medical Group, Kaiser Permanente (KP) West Los Angeles Medical Center, Los Angeles, CA. Jay Rho, Pharm.D., is Senior Director, K P, Pasadena, CA. Marlene Morcos, Pharm.D., is Inpatient Pharmacy Supervisor; and Jim Nomura, M.D., is Chief of Infectious Diseases, KP Los Angeles Medical Center, Los Angeles, CA. Donald Kaplan, Pharm.D., is Inpatient Pharmacy Practice Coordinator, Southern California Region, KP National Pharmacy Programs and Services, Downey, CA. Keith Sakamoto, Pharm.D., is Inpatient Pharmacy Specialist, KP West Los Angeles Medical Center. Doan Bui, Pharm.D., is Inpatient Pharmacy Specialist; and Sandy Yoo, Pharm.D., is Inpatient Pharmacy Specialist, KP Los Angeles Medical Center. Jason Jones, Ph.D., is Executive Director, Clinical Intelligence and Decision Support, KP, Pasadena, CA.
authors.forename: Marlene
authors.initials: M
authors.lastname: Morcos
authors.affiliation: Kalvin Yu, M.D., is Regional Chief of Infectious Diseases, Southern California Permanente Medical Group, Kaiser Permanente (KP) West Los Angeles Medical Center, Los Angeles, CA. Jay Rho, Pharm.D., is Senior Director, K P, Pasadena, CA. Marlene Morcos, Pharm.D., is Inpatient Pharmacy Supervisor; and Jim Nomura, M.D., is Chief of Infectious Diseases, KP Los Angeles Medical Center, Los Angeles, CA. Donald Kaplan, Pharm.D., is Inpatient Pharmacy Practice Coordinator, Southern California Region, KP National Pharmacy Programs and Services, Downey, CA. Keith Sakamoto, Pharm.D., is Inpatient Pharmacy Specialist, KP West Los Angeles Medical Center. Doan Bui, Pharm.D., is Inpatient Pharmacy Specialist; and Sandy Yoo, Pharm.D., is Inpatient Pharmacy Specialist, KP Los Angeles Medical Center. Jason Jones, Ph.D., is Executive Director, Clinical Intelligence and Decision Support, KP, Pasadena, CA.
authors.forename: Jim
authors.initials: J
authors.lastname: Nomura
authors.affiliation: Kalvin Yu, M.D., is Regional Chief of Infectious Diseases, Southern California Permanente Medical Group, Kaiser Permanente (KP) West Los Angeles Medical Center, Los Angeles, CA. Jay Rho, Pharm.D., is Senior Director, K P, Pasadena, CA. Marlene Morcos, Pharm.D., is Inpatient Pharmacy Supervisor; and Jim Nomura, M.D., is Chief of Infectious Diseases, KP Los Angeles Medical Center, Los Angeles, CA. Donald Kaplan, Pharm.D., is Inpatient Pharmacy Practice Coordinator, Southern California Region, KP National Pharmacy Programs and Services, Downey, CA. Keith Sakamoto, Pharm.D., is Inpatient Pharmacy Specialist, KP West Los Angeles Medical Center. Doan Bui, Pharm.D., is Inpatient Pharmacy Specialist; and Sandy Yoo, Pharm.D., is Inpatient Pharmacy Specialist, KP Los Angeles Medical Center. Jason Jones, Ph.D., is Executive Director, Clinical Intelligence and Decision Support, KP, Pasadena, CA.
authors.forename: Donald
authors.initials: D
authors.lastname: Kaplan
authors.affiliation: Kalvin Yu, M.D., is Regional Chief of Infectious Diseases, Southern California Permanente Medical Group, Kaiser Permanente (KP) West Los Angeles Medical Center, Los Angeles, CA. Jay Rho, Pharm.D., is Senior Director, K P, Pasadena, CA. Marlene Morcos, Pharm.D., is Inpatient Pharmacy Supervisor; and Jim Nomura, M.D., is Chief of Infectious Diseases, KP Los Angeles Medical Center, Los Angeles, CA. Donald Kaplan, Pharm.D., is Inpatient Pharmacy Practice Coordinator, Southern California Region, KP National Pharmacy Programs and Services, Downey, CA. Keith Sakamoto, Pharm.D., is Inpatient Pharmacy Specialist, KP West Los Angeles Medical Center. Doan Bui, Pharm.D., is Inpatient Pharmacy Specialist; and Sandy Yoo, Pharm.D., is Inpatient Pharmacy Specialist, KP Los Angeles Medical Center. Jason Jones, Ph.D., is Executive Director, Clinical Intelligence and Decision Support, KP, Pasadena, CA.
authors.forename: Keith
authors.initials: K
authors.lastname: Sakamoto
authors.affiliation: Kalvin Yu, M.D., is Regional Chief of Infectious Diseases, Southern California Permanente Medical Group, Kaiser Permanente (KP) West Los Angeles Medical Center, Los Angeles, CA. Jay Rho, Pharm.D., is Senior Director, K P, Pasadena, CA. Marlene Morcos, Pharm.D., is Inpatient Pharmacy Supervisor; and Jim Nomura, M.D., is Chief of Infectious Diseases, KP Los Angeles Medical Center, Los Angeles, CA. Donald Kaplan, Pharm.D., is Inpatient Pharmacy Practice Coordinator, Southern California Region, KP National Pharmacy Programs and Services, Downey, CA. Keith Sakamoto, Pharm.D., is Inpatient Pharmacy Specialist, KP West Los Angeles Medical Center. Doan Bui, Pharm.D., is Inpatient Pharmacy Specialist; and Sandy Yoo, Pharm.D., is Inpatient Pharmacy Specialist, KP Los Angeles Medical Center. Jason Jones, Ph.D., is Executive Director, Clinical Intelligence and Decision Support, KP, Pasadena, CA.
authors.forename: Doan
authors.initials: D
authors.lastname: Bui
authors.affiliation: Kalvin Yu, M.D., is Regional Chief of Infectious Diseases, Southern California Permanente Medical Group, Kaiser Permanente (KP) West Los Angeles Medical Center, Los Angeles, CA. Jay Rho, Pharm.D., is Senior Director, K P, Pasadena, CA. Marlene Morcos, Pharm.D., is Inpatient Pharmacy Supervisor; and Jim Nomura, M.D., is Chief of Infectious Diseases, KP Los Angeles Medical Center, Los Angeles, CA. Donald Kaplan, Pharm.D., is Inpatient Pharmacy Practice Coordinator, Southern California Region, KP National Pharmacy Programs and Services, Downey, CA. Keith Sakamoto, Pharm.D., is Inpatient Pharmacy Specialist, KP West Los Angeles Medical Center. Doan Bui, Pharm.D., is Inpatient Pharmacy Specialist; and Sandy Yoo, Pharm.D., is Inpatient Pharmacy Specialist, KP Los Angeles Medical Center. Jason Jones, Ph.D., is Executive Director, Clinical Intelligence and Decision Support, KP, Pasadena, CA.
authors.forename: Sandy
authors.initials: S
authors.lastname: Yoo
authors.affiliation: Kalvin Yu, M.D., is Regional Chief of Infectious Diseases, Southern California Permanente Medical Group, Kaiser Permanente (KP) West Los Angeles Medical Center, Los Angeles, CA. Jay Rho, Pharm.D., is Senior Director, K P, Pasadena, CA. Marlene Morcos, Pharm.D., is Inpatient Pharmacy Supervisor; and Jim Nomura, M.D., is Chief of Infectious Diseases, KP Los Angeles Medical Center, Los Angeles, CA. Donald Kaplan, Pharm.D., is Inpatient Pharmacy Practice Coordinator, Southern California Region, KP National Pharmacy Programs and Services, Downey, CA. Keith Sakamoto, Pharm.D., is Inpatient Pharmacy Specialist, KP West Los Angeles Medical Center. Doan Bui, Pharm.D., is Inpatient Pharmacy Specialist; and Sandy Yoo, Pharm.D., is Inpatient Pharmacy Specialist, KP Los Angeles Medical Center. Jason Jones, Ph.D., is Executive Director, Clinical Intelligence and Decision Support, KP, Pasadena, CA.
authors.forename: Jason
authors.initials: J
authors.lastname: Jones
mesh_terms: D000890:Anti-Infective Agents / Q000191:economics / Q000627:therapeutic use*; D003141:Communicable Diseases / Q000188:drug therapy / Q000191:economics; D017046:Cost Savings; D016527:Drug Costs; D006761:Hospitals; D006801:Humans; D005791:Patient Care / Q000191:economics / Q000592:standards; D010348:Patient Care Team / Q000458:organization & administration*; D010595:Pharmacists / Q000458:organization & administration*; D010607:Pharmacy Service, Hospital / Q000458:organization & administration*; D024382:Professional Role; D012189:Retrospective Studies
chemical_list: D000890:Anti-Infective Agents