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.

Keywords: antimicrobial stewardship; outcome measure; patient safety; process measure; quality metrics..

Figure 1.

Results of comprehensive literature review to identify candidate patient-level antimicrobial stewardship metrics. A comprehensive literature review included an initial PubMed search, followed by abstract review to apply exclusion criteria to best reflect metrics intended to demonstrate the impact of patient-level stewardship interventions in acute-care hospitals. Each included article underwent in-depth review for extraction of metrics. Primary references were added to metric review as necessary. The metrics list was de-duplicated; similar metrics were grouped together and summarized under a single description within each of the 5 broad categories.