title: Expert Consensus on Metrics to Assess the Impact of Patient-Level Antimicrobial Stewardship Interventions in Acute-Care Settings.
abstract: Antimicrobial stewardship programs (ASPs) positively impact patient care, but metrics to assess ASP impact are poorly defined. We used a modified Delphi approach to select relevant metrics for assessing patient-level interventions in acute-care settings for the purposes of internal program decision making. An expert panel rated 90 candidate metrics on a 9-point Likert scale for association with 4 criteria: improved antimicrobial prescribing, improved patient care, utility in targeting stewardship efforts, and feasibility in hospitals with electronic health records. Experts further refined, added, or removed metrics during structured teleconferences and re-rated the retained metrics. Six metrics were rated >6 in all criteria: 2 measures of Clostridium difficile incidence, incidence of drug-resistant pathogens, days of therapy over admissions, days of therapy over patient days, and redundant therapy events. Fourteen metrics rated >6 in all criteria except feasibility were identified as targets for future development.
authors.affiliation: Duke University Medical Center, Department of Medicine, Division of Infectious Diseases, and rebekah.moehring@duke.edu.|Duke Antimicrobial Stewardship Outreach Network, Durham, North Carolina.
authors.forename: Rebekah W
authors.initials: RW
authors.lastname: Moehring
authors.affiliation: Duke University Medical Center, Department of Medicine, Division of Infectious Diseases, and.|Duke Antimicrobial Stewardship Outreach Network, Durham, North Carolina.
authors.forename: Deverick J
authors.initials: DJ
authors.lastname: Anderson
authors.affiliation: Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Ronda L
authors.initials: RL
authors.lastname: Cochran
authors.affiliation: Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Lauri A
authors.initials: LA
authors.lastname: Hicks
authors.affiliation: Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Arjun
authors.initials: A
authors.lastname: Srinivasan
authors.affiliation: Duke University Medical Center, Department of Medicine, Division of Infectious Diseases, and.|Duke Antimicrobial Stewardship Outreach Network, Durham, North Carolina.
authors.forename: Elizabeth S
authors.initials: ES
authors.lastname: Dodds Ashley
mesh_terms: D000890:Anti-Infective Agents / Q000627:therapeutic use*; D016360:Clostridioides difficile; D003141:Communicable Diseases / Q000188:drug therapy* / Q000453:epidemiology*; D011307:Drug Prescriptions / Q000592:standards*; D024881:Drug Resistance, Bacterial; D004761:Enterocolitis, Pseudomembranous / Q000188:drug therapy / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D010343:Patient Admission; D005791:Patient Care / Q000592:standards*; D061214:Patient Safety; D015397:Program Evaluation / Q000379:methods*; D016896:Treatment Outcome; D014481:United States
chemical_list: D000890:Anti-Infective Agents
keywords: antimicrobial stewardship; outcome measure; patient safety; process measure; quality metrics.