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. 2024 Jun 8;10(12):e32750.
doi: 10.1016/j.heliyon.2024.e32750. eCollection 2024 Jun 30.

Effects of pay-for-performance based antimicrobial stewardship on antimicrobial consumption and expenditure: An interrupted time series analysis

Haohai Xia  1 , Jia Li  2 , Xinyi Yang  1 , Yingchao Zeng  1 , Lin Shi  1 , Weibin Li  1 , Xu Liu  3 , Shifang Yang  4 , Manzhi Zhao  4 , Jie Chen  2 , Lianping Yang  1
Affiliations

Effects of pay-for-performance based antimicrobial stewardship on antimicrobial consumption and expenditure: An interrupted time series analysis

Haohai Xia et al. Heliyon. .

Abstract

Objectives: To evaluate the impact of pay-for-performance on antimicrobial consumption and antimicrobial expenditure in a large teaching hospital in Guangzhou, China.

Methods: We collected data from hospital information system from January 2018 through September 2022 in the inpatient wards. Antimicrobial consumption was evaluated using antibiotic use density (AUD) and antibiotic use rate (AUR). The economic impact of intervention was assessed by antimicrobial expenditure percentage. The data was analyzed using interrupted time series (ITS) analysis.

Results: Following the implementation of the intervention, immediate decreases in the level of AUD were observed in Department of Hematology Unit 3 (β = -66.93 DDDs/100PD, P = 0.002), Urology (β = -32.80 DDDs/100PD, P < 0.001), Gastrointestinal Surgery Unit 3 (β = -11.44 DDDs/100PD, P = 0.03), Cardiac Surgery (β = -14.30 DDDs/100PD, P = 0.01), ICU, Unit 2 (β = -81.91 DDDs/100PD, P = 0.02) and Cardiothoracic Surgery ICU (β = -41.52 DDDs/100PD, P = 0.05). Long-term downward trends in AUD were also identified in Organ Transplant Unit (β = -1.64 DDDs/100PD, P = 0.02). However, only Urology (β = -6.56 DDDs/100PD, P = 0.02) and Gastrointestinal Surgery Unit 3 (β = -8.50 %, P = 0.01) showed an immediate decrease in AUR, and long-term downward trends in AUR were observed in Pediatric ICU (β = -1.88 %, P = 0.05) and ICU Unit 1 (β = -0.55 %, P = 0.02).

Conclusion: This study demonstrates that the adoption of pay-for-performance effectively reduces antibiotic consumption in specific departments of a hospital in Guangzhou in the short term. However, it is important to recognize that the long-term impact of such interventions is often limited. Additionally, it should be noted that the overall effectiveness of the intervention across the entire hospital was not significant.

Keywords: Antimicrobial consumption; Antimicrobial stewardship; Interrupted time series analysis; One-off bonus payment; Penalty.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
Results of the ITS analysis of total hospital antibiotic use density (A), antibiotic use rate (B) and antibiotic expenditure/medication expenditure (C).
Fig. 2
Fig. 2
Results of the ITS analysis of Internal Medicine system antibiotic use density. A: Department of Hematology, Unit 1; B: Department of Hematology, Unit 3;C: Emergency Ward.
Fig. 3
Fig. 3
Results of the ITS analysis of Surgical system antibiotic use density. A: Urology; B: Gastrointestinal Surgery, Unit 3; C: Cardiac Surgery; D: Organ Transplant Unit.
Fig. 4
Fig. 4
Results of the ITS analysis of ICU System antibiotic use density. A: Pediatric ICU; B: Neurology ICU; C: ICU, Unit 2; D: Cardiothoracic Surgery ICU.
Fig. 5
Fig. 5
Results of the ITS analysis of Internal Medicine system antibiotic use rate. A: Department of Pediatrics, Unit 2; B: Emergency Ward.
Fig. 6
Fig. 6
Results of the ITS analysis of Surgical system antibiotic use rate. A: Urology; B: Gastrointestinal Surgery, Unit 3; C: Microsurgery.
Fig. 7
Fig. 7
Results of the ITS analysis of ICU system antibiotic use rate.
See this image and copyright information in PMC

References

    1. O’Neill, J. Tackling drug-resistant infections globally: final report and recommendations. (Government of the United Kingdom, May 2016). Available from: https://amr-review.org/sites/default/files/160525_Final%20paper_with%20c..., access on 12 June, 2024.
    1. Tiri B., et al. Antimicrobial stewardship program, COVID-19, and infection control: spread of carbapenem-resistant Klebsiella pneumoniae colonization in ICU COVID-19 patients. What did not work? J. Clin. Med. 2020;9(9) - PMC - PubMed
    1. Li J., et al. Etiology and antimicrobial resistance of secondary bacterial infections in patients hospitalized with COVID-19 in Wuhan, China: a retrospective analysis. Antimicrob. Resist. Infect. Control. 2020;9(1):153. - PMC - PubMed
    1. Contou D., et al. Bacterial and viral co-infections in patients with severe SARS-CoV-2 pneumonia admitted to a French ICU. Ann. Intensive Care. 2020;10(1):119. - PMC - PubMed
    1. Sharifipour E., et al. Evaluation of bacterial co-infections of the respiratory tract in COVID-19 patients admitted to ICU. BMC Infect. Dis. 2020;20(1):646. - PMC - PubMed

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