Statewide Antibiotic Stewardship: : An eBrightHealth Choosing Wisely Initiative

Abstract

Objective: To implement a collaborative statewide antibiotic stewardship initiative in both the ambulatory and inpatient settings.

Methods: Five participating Delaware health systems each convened internal team(s) to translate the vision set forth by the eBrightHealth LLC Choosing Wisely Work Group into clinical action through process improvement efforts at their institutions. The teams focused on implementing antibiotic time-outs, and on improving antibiotic prescribing for upper respiratory infections in ambulatory settings. The learning network utilized an "all teach, all learn" methodology via monthly conference calls and quarterly face-to-face meetings.

Results: All inpatient teams implemented antibiotic time-outs for at least 1 unit. Other interventions included commitment posters; submitting antibiotic utilization data nationally; provider/patient surveys; local stewardship champions; and provider prescribing data feedback. Barriers to implementation included competing priorities, lack of reliable utilization data, and suboptimal provider engagement. Overall antibiotic utilization decreased by 9%, compared to the pre-intervention period.

Conclusions: This initiative has demonstrated the value of multidisciplinary teams, from varying healthcare systems, coming together to work on a single project. While each team's interventions and specific goals differed slightly, all teams implemented new initiatives to promote appropriate use of antibiotics.

Policy implications: Antibiotic stewardship is a national priority. Acute care hospitals are required to have antibiotic stewardship programs; similar programs are proposed for ambulatory settings.

Figure 1

Health system partners participating in eBrightHealth LLC Strategic Alliance, and eBright Health Accountable Care Organization (ACO).

Figure 2

Antibiotic stewardship interventions in place prior to the eBrightHealth Choosing Wisely initiative (blue bars), and either continued or initiated during the project (red bars).

Figure 3

Outpatient antibiotic utilization among Delaware Medicare Part D beneficiaries, 2016 quarter 1 through 2018 quarter 2, based on claims data.

Figure 4

Outpatient antibiotic utilization among Delaware Medicare Part D beneficiaries, comparing eBH pre-intervention (2016 Q3-2017 Q2) to intervention (2017 Q3-2018 Q2) periods.