Calculation and Feedback of Risk-Adjusted Antibiotic Days as a Process Measure in a Statewide Trauma Collaborative.

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العنوان:	Calculation and Feedback of Risk-Adjusted Antibiotic Days as a Process Measure in a Statewide Trauma Collaborative.
المؤلفون:	Sangji NF; Department of Surgery, University of Michigan, Ann Arbor, MI, USA.; Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI, USA.; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA., Dougherty JM; Department of Surgery, University of Michigan, Ann Arbor, MI, USA.; Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI, USA., Tignanelli CJ; Department of Surgery, University of Minnesota, Minneapolis, MN, USA.; Center for Learning Health Systems Science, University of Minnesota, Minneapolis, MN, USA., Maqsood HA; Department of Surgery, University of Michigan, Ann Arbor, MI, USA.; Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI, USA., Cain-Nielsen AH; Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI, USA., Oliphant BW; Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI, USA.; Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA., Hemmila MR; Department of Surgery, University of Michigan, Ann Arbor, MI, USA.; Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI, USA.; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA.
المصدر:	The American surgeon [Am Surg] 2024 May 21, pp. 31348241256070. Date of Electronic Publication: 2024 May 21.
Publication Model:	Ahead of Print
نوع المنشور:	Journal Article
اللغة:	English
بيانات الدورية:	Publisher: SAGE Publications in association with Southeastern Surgical Congress Country of Publication: United States NLM ID: 0370522 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1555-9823 (Electronic) Linking ISSN: 00031348 NLM ISO Abbreviation: Am Surg Subsets: MEDLINE
أسماء مطبوعة:	Publication: 2020- : [Thousand Oaks, CA] : SAGE Publications in association with Southeastern Surgical Congress Original Publication: Atlanta Ga : Southeastern Surgical Congress
مستخلص:	Background: Optimization of antibiotic stewardship requires determining appropriate antibiotic treatment and duration of use. Our current method of identifying infectious complications alone does not attempt to measure the resources actually utilized to treat infections in patients. We sought to develop a method accounting for treatment of infections and length of antibiotic administration to allow benchmarking of trauma hospitals with regard to days of antibiotic use. Methods: Using trauma quality collaborative data from 35 American College of Surgeons (ACS)-verified level I and level II trauma centers between November 1, 2020, and January 31, 2023, a two-part model was created to account for (1) the odds of any antibiotic use, using logistic regression; and (2) the duration of usage, using negative binomial distribution. We adjusted for injury severity, presence/type of infection (eg, ventilator-acquired pneumonia), infectious complications, and comorbid conditions. We performed observed-to-expected adjustments to calculate each center's risk-adjusted antibiotic days, bootstrapped Observed/Expected (O/E) ratios to create confidence intervals, and flagged potential high or low outliers as hospitals whose confidence intervals lay above or below the overall mean. Results: The mean antibiotic treatment days was 1.98°days with a total of 88,403 treatment days. A wide variation existed in risk-adjusted antibiotic treatment days (.76°days to 2.69°days). Several hospitals were identified as low (9 centers) or high (6 centers) outliers. Conclusion: There exists a wide variation in the duration of risk-adjusted antibiotic use amongst trauma centers. Further study is needed to address the underlying cause of variation and for improved antibiotic stewardship. Competing Interests: Competing InterestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Anne H. Cain-Nielsen and Mark R. Hemmila receive salary support from Blue Cross Blue Shield of Michigan and Blue Care Network (a nonprofit mutual company) through grant funding of the Michigan Trauma Quality Improvement Program and from the Michigan Department of Health and Human Services through grant funding of the Michigan Trauma Quality Improvement Program. The remaining authors have no conflicts to disclose.
فهرسة مساهمة:	Keywords: antibiotic stewardship; infectious treatment; quality improvement; trauma center performance
تواريخ الأحداث:	Date Created: 20240521 Latest Revision: 20240521
رمز التحديث:	20240521
DOI:	10.1177/00031348241256070
PMID:	38770751
قاعدة البيانات:	MEDLINE

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تدمد:	1555-9823
DOI:	10.1177/00031348241256070