outpatient antibiotic stewardship initiative “open office
TRANSCRIPT
Outpatient Antibiotic Stewardship Initiative “Open Office Hours”
Matt Lincoln, MBA Director, Administrative Operations
Health Services Advisory Group (HSAG)
Thursday, February 1, 2018
Objectives
At the conclusion of this webinar, attendees will be able to: • Identify common barriers to implementing the Centers
for Disease Control and Prevention (CDC) Core Elements of Outpatient Antibiotic Stewardship (AS).
• Apply best practices recommended during the webinar.
• Request additional individualized technical assistance offered by HSAG staff members, peers, or other subject-matter experts.
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What is a Quality Innovation Network-Quality Improvement Organization (QIN-QIO)?
Funded by the Centers forMedicare & MedicaidServices (CMS)– Dedicated to improving health
quality at the community level– Ensures people with Medicare and
Medicaid get the care theydeserve
– Improves care for everyone– Largest federal program
dedicated to improving health quality at the community level
Department ofHealth & Human
Services
CMS
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HSAG’s QIN-QIO Territory
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Nearly 25 percent of the nation’s Medicare beneficiaries
HSAG is the Medicare QIN-QIO for Arizona, California, Florida, Ohio, and the U.S. Virgin Islands.
Quality Innovation Network-Quality Improvement Organization (QIN-QIO)
AS is the Effort to…
• Improve prescribing by clinicians and use by patients so that antibiotics are only prescribed and used when needed.
• Minimize misdiagnoses or delayed diagnoses leading to underuse of antibiotics.
• Ensure that the right drug, dose, and duration are selected when an antibiotic is needed.
• Measure antibiotic prescribing.
The goal of AS is to maximize the benefit of treatment while minimizing harm to individuals and communities.
5Sources: 1. CDC. MMWR, vol.65. No. 6, Nov. 11, 2016. https://www.cdc.gov/mmwr/volumes/65/rr/pdfs/rr6506.pdf. 2. CDC. Antibiotic resistance threats in the United States, 2013 [Internet]. Atlanta, GA: US Department of Health and Human Services, CDC; 2013.3. Barlam TF, Cosgrove SE, Abbo LM, et al. Implementing an Antibiotic Stewardship Program: Guidelines by the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America. Clin Infect Dis 2016;62:e51–77
Project Timeline
2016 2017 2018
Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3
Recruitment
Baseline Self-Assessment
Kickoff Webinar
Monthly “Office Hours”
Quarterly Check-in
“Bite-Size” Webinars
Today All 4 CEs met
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Suggested Project Timeline*
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CommitmentSeptember 2017
Action for Policy and
PracticeNovember 2017
Tracking and ReportingMarch 2018
Education and ExpertiseMay 2018
* Timeline is not evidence-based and is provided for discussion purposes only.
CDC Core Elements of Outpatient AS (November 2016)
• Provides a framework for AS for outpatient clinicians and facilities that routinely provide antibiotic treatment
• Augments existing guidance for other clinical settings:– Core Elements of
Hospital AS Programs (2014)
– Core Elements of AS for Nursing Homes (2015)
8 Source: CDC. MMWR, vol.65. No. 6, Nov. 11, 2016. https://www.cdc.gov/mmwr/volumes/65/rr/pdfs/rr6506.pdf.
Core Elements of Outpatient Antibiotic Stewardship
Commitment: Demonstrate dedication to and accountability for optimizing antibiotic prescribing and patient safety.Action for policy and practice: Implement at least one policy or practice to improve antibiotic prescribing, assess whether it is working, and modify as needed.
Tracking and reporting: Monitor antibiotic prescribing practices and offer regular feedback to clinicians or have clinicians asses their own antibiotic use.
Education and expertise: Provide educational resources to clinicians and patients on antibiotic prescribing and ensure access to needed expertise on antibiotic prescribing.
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Core Element #1 Commitment
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Core Element #2 Action
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CDC Adult Treatment Recommendations
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Summarizes recommendations for appropriate antibiotic prescribing for adults seeking care in an outpatient setting
Source: CDC:
• Acute rhinosinusitis• Acute uncomplicated bronchitis• Common cold or non-specific upper
respiratory tract infection (URI)• Pharyngitis• Acute uncomplicated cystitis
https://www.cdc.gov/antibiotic-use/community/for-hcp/outpatient-hcp/adult-treatment-rec.html
CMA Foundation Project AWARE
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CMA Foundation AWARE. Compendium Aware 2017-Acute Respiratory Tract Infection Guidelines. https://itunes.apple.com/us/app/aware-compendia-app-toolkit/id913606319?mt=8&ign-mpt=uo%3D4.CMA Foundation AWARE. Acute Infection Guideline Summary brochure.2016. http://www.thecmafoundation.org/Portals/0/assets/docs/Physician-Resources/AWARE/compendium-adult-2016-11x17-final-web.pdf?ver=2016-12-14-090913-470
Viral Prescription Pads
16 Source: CDC: https://www.cdc.gov/antibiotic-use/community/pdfs/aaw/CDC-AU_RCx_Relief_for_Viral_Illness_sm_v8_508.pdf
Delayed Prescribing
17 Source: CDC. https://www.cdc.gov/antibiotic-use/community/pdfs/aaw/CDC-AU_RCx_Delayed_Prescribing_lg_v9_508.pdf
Watchful Waiting
18 Source: CDC. https://www.cdc.gov/antibiotic-use/community/pdfs/aaw/CDC-AU_RCx_Watchful_Waiting_lg_v10_508.pdf
Physician to Patient Communication Strategies Recorded Webinar
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Webinar Speakers:• Dr. Lauri Hicks, CDC• Dr. Rita Mangione-Smith, University
of Washington, Department of Pediatrics
Focus:• Optimizing communication with
parents during pediatric visits for acute respiratory tract infections
• Much of the content translates to adult population and frail elderly patients with caregivers
https://www.youtube.com/watch?v=3yI9wLgwMKM&feature=youtu.be
Core Element #3 Tracking and Reporting
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Steps to Track Antibiotic Prescribing
Overview:• Chart review and
assessment are fundamental to improving healthcare quality.
• This sheet is designated as a “bare minimum” guide to auditing appropriate antibiotic use for acute bronchitis in otherwise healthy adults.
Source: Telligen. https://www.hsag.com/contentassets/a4089e467b61495c9fdb701b86e854db/bronchitis_self-audit_20170825_fnlv2_508.pdf21
Four Key Components Audit Process
1. Pull visit charts with diagnosis of acute bronchitis, and apply inclusion and exclusion criteria
2. Determine the number of uncomplicated bronchitis visits in which antibiotics were prescribed
3. Calculate prescribing rates for acute bronchitis
4. Compare observed prescribing rate to recommended prescribing rate
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Example Sheet for Tracking Antibiotic Prescribing for Acute Bronchitis
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Antibiogram Toolkit
• Cumulative antibiogram report is used to guide initial empirical antimicrobial therapy decisions when definitive microbiological susceptibilities are unavailable for the infecting pathogen(s).
• Toolkit provides direction for clinicians involved in creating the cumulative antibiogram report and educating clinicians on its use.
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Core Element #4 Education and Expertise
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“Bite-Size” Webinars
• Practical strategies to improve infection prevention and AS
• Common barriers that lead to deviation from best practices
• Identifying high-priority conditions for intervention
• Using clinical practice guidelines to establish expectations for appropriate prescribing
• Strategies to improve provider patient communication
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Patient Education Resources
27Sources:English: http://consumerhealthchoices.org/wp-content/uploads/2015/02/3AntibioticsTri-Fold_DownloadGenericFINAL.pdfSpanish: http://consumerhealthchoices.org/wp-content/uploads/2015/02/3AntibioticsTri-Fold_DownloadGenericSpanish_Final.pdf
Patient Education Resources (cont.)
28 Source: CDC. https://www.cdc.gov/antibiotic-use/community/pdfs/aaw/AU_viruses-or-bacteria-Chart_508.pdf
Waiting Room Video Now Available!
29https://www.youtube.com/playlist?list=PLfm1t1zOVVIMvxtMUCx0z-pBwB8Qe1ap9
Online CME Course—“To Prescribe or Not To Prescribe? Antibiotics and Outpatient Infections”• Communication training activity
from Stanford University• Provides practical approach to
management of common outpatient infections
• Uses both instructional and interactive videos and patient role plays
• 1.75 CME credits offered
https://med.stanford.edu/cme/courses/online/improving-antibiotics-pcs.html
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Continuing Education Opportunities
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Available from the CDC• Healthcare Professionals
• https://www.conversationsforhealth.com/antibiotics/
• Medical Students
• http://www.wakehealth.edu/School/CAUSE/Get-Smart-About-Antibiotics.htm
• Pharmacists
• https://www.cdc.gov/getsmart/community/for-hcp/pharmacists-ce-courses.html
Main CDC Link: https://www.cdc.gov/getsmart/community/for-hcp/continuing-education.html
Provider Education Resources (cont.)
32 Source: LACDPH. 2016. http://publichealth.lacounty.gov/acd/docs/ABPoster3.pdf.
Next Steps
• Attend monthly “office-hours” coaching calls every first Thursday at 12 Noon PT next call—March 1, 2018.
• Schedule quarterly check-in call with HSAG specialist before March 31, 2018.
• Contact HSAG at any time to be connected with AS subject-matter experts for coaching or troubleshooting.
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Poll Question #1
Which CDC Core Element of Outpatient AS would you like to focus on during the next Open Office Hours Webinar?
A. Commitment
B. Action
C. Tracking and Reporting
D. Education and Expertise
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Thank you!
Matt Lincoln, MBA, Director, Administrative Operations,
Health Services Advisory Group (HSAG)[email protected]
Keith Chartier, MPHAssociate Director, HSAG
Eli DeLille, RN, BSN, CICQuality Improvement Specialist/Infection
Preventionist, [email protected]
Please complete the evaluation at:
https://goo.gl/tL2EZxIf you registered online for this event, you will also receive the link via email.
A recording of today’s session will be available at:www.hsag.com/events
(Click on today’s event date to access the recording link)
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This material was prepared by Health Services Advisory Group, the Medicare Quality Improvement Organization for California, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department
of Health and Human Services. The contents presented do not necessarily reflect CMS policy. Publication No. CA-11SOW-C.3.10-01302018-01.